• Assessment
    When do thermic effect of food peaks occur in old and very old adults?
    • Conclusion

      One 3-hour study (Visser M et al, 1995) of neutral research design quality reports the peak post-prandial energy expenditure was significantly delayed in the 103 older adults (67-79 years) compared to 56 younger adults (21-29 years) with peaks at 65-80 minutes and 50-65 minutes, respectively).  A second study of neutral research design of 15 older men (61-77 y) and 15 young men (19-25 y) also showed delayed peaks in older v. younger, with peaks at 90 and 60 minutes, respectively.  

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    Over a 3-hour measurement interval and in older adult populations, what are the thermic effect of feeding (TEF) increases on RMR, expressed as % of energy ingested?
    • Conclusion

      There are no studies reporting the thermic effect of feeding (TEF) increases on RMR, expressed as % of energy ingested and using area under the curve analysis in older adults.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    Over a 4-hour measurement interval, what are the thermic effect of feeding (i.e., meal or snack) increases on RMR in non-obese, obese and older adults that can be expressed as % of energy ingested?
    • Conclusion

      No studies report group mean percent thermic effect of meal test over a 4-hour measurement duration expressed as a percent of energy ingested in non-obese, obese and older adult populations. 

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    Overall, what period of fasting is required in adults (including obese and older adults) to avoid error in the RMR measurement resulting from the thermic effect of feeding (TEF) )(e.g., meal or snack)?
    • Conclusion

      In most individuals, a fast of at least 5 hours prior to RMR measurement is preferred to reduce any impact of diet-induced thermogenesis, which is generally 7-9% of kcal consumed. 

      However, if a 5-hour fast would create medical risks (i.e., diabetes mellitus), then a fast of at least 4 hours prior to a RMR measurement could be adequate to reduce any impact of diet-induced thermogenesis if a small meal (i.e., 400 kcals or less) is consumed. 

      If a very large meal (>900 kcal) is consumed within 5-hours of a RMR measurement, then a longer time (at least 6 hours) is recommended to reduce diet-induced thermogenesis impact on RMR to clinically insignificant levels (<100 kcals/day) in individuals.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.