EE: Thermic Effect of Food (2014)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
  1. Identify the magnitude and duration of the residual effect of a 3-h exercise (50%VO2max) in terms of energy expenditure
  2. Determine the nature of fuel oxidized when a mixed meal is ingested during the recovery period.
Inclusion Criteria:
  1. Understand and give written consent
  2. Healthy
  3. Not on any special diet
  4. Not using any medication
  5. Nonsmoker.
Exclusion Criteria:
  1. Refusal to consent
  2. Not meeting inclusion criteria.
Description of Study Protocol:
  • Two parts: On Day 1 (control period) and Day 2 (an exercise period including a 3-h exercise on a treadmill at 50% VO2max. No randomization since a prolonged (i.e., >24 h) effect of the exercise could not be excluded. Energy expenditure was monitored for 42 h nearly continuously from 1400 on day I up to 0800 in the morning following day II.
  • Day 2: Exercise period consisted of performing on a treadmill for 3 consecutive h (from 1100 to 1400 h)


  • Ht measured? Yes
  • Wt measured? Yes
  • Fat-free mass measured? Yes, underwater weighing


  • Monitored heart rate? Yes
  • Body temperature? No
  • Medications administered? No
  • Monitored blood pressure

Resting energy expenditure

  • IC type: Ventilated-hood
  • Equipment of Calibration: Yes
  • Coefficient of variation using std gases: No
  • Rest before measure (state length of time rested if available): Not specified
  • Measurement length: 2 min
  • Measurement duration: 5 h
  • Steady state: Not specified
  • Fasting length: 6 hr
  • Exercise restrictions XX hr prior to test? 48 hr
  • Room temp: Room calorimeter temp monitored
  • No. of measures within the measurement period: Baseline, and continuous for 240 mins after eating
  • Were some measures eliminated? No
  • Were a set of measurements averaged? Yes, every 2 minutes of a continuous measure
  • Coefficient of variation in subjects’ measures? No
  • Training of measurer? Likely
  • Subject training of measuring process? Yes


  • On Control Day (after baseline measurement), subjects were given a mixed meal at 1430 and the metabolic response at rest was continuously followed from 1500-1900 using a ventilated hood.
  • Test meal was bread, low fat Swiss cheese, butter, OJ, chocolate bar and coffee flavored milkshake
  • Kcal content: 1300±50 (SEM), 55% CHO, 18% Protein, 27% fat.

[Analyst note: the exercise period day was not appraised]

Data Collection Summary:

Outcome(s) and other measures

  1. Measured REE [(VO2, l/min), VCO2 (l/min; ml/kg/min), RER, ventilation (l/min)].
  2. Independent variables of weight, height, age, % body fat
  3. Estimate of maximal oxygen consumption
  4. Blood samples to evaluate glucose, free fatty acids, plasma glycerol, immunoreactive insulin, plasma glucagons, BUN
  5. Urine samples analyzed for urinary nitrogen, creatinine, 3-methyl-histidine, epinephrine, norepinephrine.

Blinding used:  No

Description of Actual Data Sample:

Younger aged males

  • N=10 young males aged 20-23 yr
  • Mean age: 21.8 y±0.3

Statistical tests

Mean values ±SEM; Student’s t test for paired values; the 4.5 h post-exercise recovery and the RMR, energy expenditure was calculated from calorimetric measurements for 2 min intervals; Values are mean of 30-min periods.

Summary of Results:


Men Mean±SD Range

Wt, kg

73.2±2.8 60.4±87.3

Ht, cm

179.8±2.5 165-191

Body fat, %




  • Number of measurement intervals: 2-baseline and continuous 180 min measure
  • Length of measurements: 30, 180 mins
  • Steady state: Not specified


RMR Results
During the control period (day I, baseline (premeal) energy expenditure was 1.35±0.02 kcal/min.

Following consumption of the test meal, peak values were achieved at 90 minutes (1.92±0.07 kcal/min) and progressively decreased to 1.71±0.05 kcal/min 4.5 h postprandial.

The net increase in energy expenditure during the 5 h postprandial phase on day (expressed relative to the energy content of the meal) was 10.5±0.8% (SEM).

The net increase in energy expenditure during the 5 h postprandial phase averaged 32.8±2.6% over premeal baseline [energy expenditure].

Author Conclusion:

As stated by the author in body of report:

  • The present study has attempted to assess the effect of an acute exercise on the energy metabolism during the recovery phase under strictly controlled conditions of measurements... Our experimental design allowed us to make up the extra cost of exercise by giving more food prior to the onset of the test (breakfast) so that the apparent energy balance of each subject at completion of the exercise would be similar to that obtained without exercise. Both test meals (lunch and dinner) were however identical in composition for each subject.”
  • “The main implication of the present study is that the post-exercise energy expenditure was moderately stimulated over 4-5 hr, as well as during RMR on the following day. This rise in energy expenditure was accompanied by a marked and continuous stimulation of lipid oxidation for at least 18 h. These results emphasize the long lasting metabolic effect of an acute bout of exercise.”
Funding Source:
University/Hospital: University of Lausanne
Reviewer Comments:


  • “Research plan controlled for differences in adiposity and FFW as well as recruiting various levels of physical activity.”
  • RMR measured continuously using a standardized protocol
  • Appropriate statistics


  • “Convenience sampling bias; Does not report middle- and older-aged adults
  • Ethnicity of subjects not reported
  • These are important variables on REE measurement accuracy: did not report steady state monitoring over the 180 minutes (i.e., 3 hrs); but was highly likely it occurred based on descriptions given in article
  • Nonvegetarians had a higher fat dietary intake and weakens theory thermic effect of a test meal was measured within 180 minutes.
  • Test meal was liquid whereas routine dietary intake differences in fiber were significant; This may also be an intervening variable.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? N/A
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? N/A
  1.3. Were the target population and setting specified? N/A
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? N/A
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? N/A
  2.4. Were the subjects/patients a representative sample of the relevant population? N/A
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) N/A
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? N/A
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.2. Were nutrition measures appropriate to question and outcomes of concern? N/A
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? N/A
  7.5. Was the measurement of effect at an appropriate level of precision? N/A
  7.6. Were other factors accounted for (measured) that could affect outcomes? N/A
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? N/A
  8.2. Were correct statistical tests used and assumptions of test not violated? N/A
  8.3. Were statistics reported with levels of significance and/or confidence intervals? N/A
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? N/A
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? N/A
  9.2. Are biases and study limitations identified and discussed? N/A
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? N/A
  10.2. Was the study free from apparent conflict of interest? N/A