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Recommendations Summary

AWM: Assess Energy Needs 2014

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    AWM: Measure Resting Metabolic Rate (RMR)

    If indirect calorimetry is available, the registered dietitian nutritionist (RDN) should use a measured resting metabolic rate to determine energy needs in overweight or obese adults. Measurement of resting metabolic rate using indirect calorimetry is more accurate than estimating resting metabolic rate using predictive equations.

    Rating: Consensus
    Conditional

    AWM: Use Mifflin-St. Jeor Equation to Estimate RMR

    If indirect calorimetry is not available, the registered dietitian nutritionist (RDN) should use the Mifflin-St. Jeor equation using actual weight to estimate resting metabolic rate (RMR) in overweight or obese adults. The majority of research reviewed supports the use of the Mifflin-St. Jeor equation (using actual body weight) to predict RMR in overweight or obese adults because it demonstrated good accuracy and correlation with indirect calorimetry.

    Rating: Strong
    Conditional

    AWM: Estimate Total Energy Needs

    The registered dietitian nutritionist (RDN) should multiply the resting metabolic rate (RMR, measured or estimated) by one of the following physical activity factors to estimate total energy needs:

    • Sedentary: 1.0 or more to less than 1.4
    • Low active: 1.4 or more to less than 1.6
    • Active: 1.6 or more to less than 1.9
    • Very active: 1.9 or more to less than 2.5.
    The Dietary Reference Intakes (DRI) Physical Activity Levels (PAL) represent the ratio of total energy expenditure to basal energy expenditure and are defined as sedentary, low active, active or very active.

    Rating: Consensus
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      The application of these recommendations depends on the availability of indirect calorimetry.

      Mifflin-St. Jeor Equations

      • Males: RMR (kcal per day) = 10 X Weight (kg) + 6.25 X Height (cm) - 5 X age (years) + 5   
      • Females: RMR (kcal per day) = 10 X Weight (kg) + 6.25 X Height (cm) - 5 X age (years) – 161.
      Dietary Reference Intake (DRI) Physical Activity Levels (PAL)
      • Sedentary: Typical daily living activities (e.g., household tasks, walking to the bus)
      • Low active: Typical daily living activities plus 30 to 60 minutes of daily moderate activity (e.g., walking at 5km to 7km per hour or 3mph to 4mph)
      • Active: Typical daily living activities plus at least 60 minutes of daily moderate activity
      • Very active: Typical daily living activities plus at least 60 minutes of daily moderate activity plus an additional 60 minutes of vigorous activity or 120 minutes of moderate activity.

    • Potential Costs Associated with Application

      • Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes.
      • If applicable, costs of equipment and staff time with the use of indirect calorimetry may be additional.

    • Recommendation Narrative

      • The majority of research reviewed supports the use of the Mifflin-St. Jeor equation (using actual body weight) to predict resting metabolic rate (RMR) in overweight or obese adults because it demonstrated good accuracy and correlation with indirect calorimetry (Scalfi et al, 1993; Frankenfield et al, 2003; St. Jeor et al, 2004; Weijs, 2008; Skouroliakou et al, 2009; Weijs and Vansant, 2010; Ruiz et al, 2011; de Oliveira et al, 2012; Faria et al, 2012)
      • Other equations evaluated did not predict resting metabolic rate as accurately as the Mifflin-St. Jeor equation (Heshka et al, 1993; Scalfi et al, 1993; Siervo et al, 2003; Livingston and Kohlstadt, 2005; Lazzer, Agosti, Resnik et al, 2007; Lazzer, Agosti, Silvestri et al, 2007; Skouroliakou et al, 2009; Spears et al, 2009; Weijs and Vansant, 2010; Horie et al, 2011; Ruiz et al, 2011; de Oliveira et al, 2012).

    • Recommendation Strength Rationale

      The Conclusion Statement in support of these recommendations received Grade I.

    • Minority Opinions

      Consensus reached.