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  • Assessment
    In healthy non-obese and obese individuals, what is the difference in RMR between measurements taken while in sitting and supine positions?
    • Conclusion

      One study of plus research design quality (i.e., using well-defined measurement positions and adherence to an RMR measurement protocol) in 24 individuals (17 women and 7 men) with a wide weight range (weight range from 48-109 kg and 19 representing non-obese individuals with the remaining 5 obese) indicates a sitting RMR measure is 69 kcals higher/day than a supine RMR.

       

    • 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.
    In healthy non-obese and obese individuals, what is the difference in RMR between measurements taken while in a semi-recumbent or semi-supine compared to supine position?
    • Conclusion

      One cross-sectional study representing two high quality research design publications (Owen et al, 1988, 1989) in 104 nonobese and obese individuals adhered to a research indirect calorimetry measurement protocol and reported RMR using a semi-recumbent position but there is no comparison group. Therefore, the kcal difference between measurements taken in a semi-recumbent or semi-supine compared to supine position in non-obese or obese adults is unknown.

    • 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.
    In healthy adults, what environmental characteristics should be controlled to ensure accurate RMR measurement?
    • Conclusion

      In settings where healthy adults obtain RMR measures, a good recommendation is to ensure that the individual is physically comfortable with the measurement position during the test and repeated measures are in the same reclined position.

    • 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.
    In postmenopausal obese women are certain body positions associated with increased metabolic rate by indirect calorimetry?
    • Conclusion

      One primary study of neutral research design quality (i.e., did not specify if rest period allowed prior to sitting measure) in 40 postmenopausal obese women (63-69 years, group mean body fat 42.4±5.4%) following a low calorie diet (i.e., 500 or 700 kcals) or low-calorie diet (500 kcals/d) and exercise suggests that within-group mean differences between RMR measured in the sitting and supine position are 5-11 kcal/hr, such that, when extrapolated to a 24 hr RMR, the group mean sitting measurement kcal difference is between 75-253 kcal/d. While range of 24-hour error is significant, this difference is interpreted with caution due to inability to distinguish measurement technique error related to inadequate rest period length from actual posture-related differences.

    • 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.
    In ill adult patients, are certain body positions associated with an increased metabolic rate when measuring by indirect calorimetry?
    • Conclusion

      One narrative review recommends supine measures of RMR in the critically ill.  One primary research study of plus quality research design measured postoperative thoracotomy patients with no intraoperative complications and reported that RMR measured in the supine position was higher than that measured at a 30 degree head of bed elevation, theoretically attributed to increased work of breathing in the supine position.  In settings to obtain RMR measures in an ill adult patient, a good recommendation is to ensure that the individual is physically comfortable with the measurement position during the test and that repeated measures are in the same position.

       

    • 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.