AWM: Estimating Resting Metabolic Rate (RMR) (2014)


de Oliveira FC, Alves RD, Zuconi CP, Ribeiro AQ, Bressan J. Agreement between different methods and predictive equations for resting energy expenditure in overweight and obese Brazilian men. J Acad Nutr Diet. 2012; 112(9): 1,415-1,420.

PubMed ID: 22939443
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
To evaluate the agreement between methods and equations for REE estimation of overweight and obese Brazilian men.
Inclusion Criteria:
  • Non-smoking men
  • Aged between 18 and 45 years
  • Body mass index from 26 to 35.5
  • Weight stable ±3kg
  • Provided written informed consent.
Exclusion Criteria:
  • Smoker
  • Presence of chronic or acute disease
  • History of eating disorder
  • Use of medications known to affect energy expenditure and or water balance (i.e., diuretics)
  • Alcohol consumers (ingestion of more than 231g alcohol per week)
  • Men reporting high levels of physical activity.
Description of Study Protocol:


Volunteers were recruited from October 2008 to October 2009 in the local community through advertisements.


Cross-sectional study.

Blinding Used

Implied with measurements.

Statistical Analysis

  • All analyses were performed using SPSS (version 17.0) and Med Calc (version 9.3.0)
  • The association between methods was determined by the intraclass coefficient and its 95% CI, which was classified according to Shoukri and Pause
  • The agreement between methods for REE was also analyzed using the Bland-Altman method with limits of agreement of ±1.96 standard deviations of residue and by percentage of the difference between IC measurement of REE and predicted REE
  • Significance level was set at 5% (P<0.05).
Data Collection Summary:

Timing of Measurements

All measurements were conducted under standardized conditions at the Laboratory of Energy Metabolism and Body Composition of the Federal University of Vicose.

Dependent Variables

  • Resting energy expenditure (REE) was carried out by indirect calorimetry for 30 minutes using the Deltatrac-R3D metabolic cart and the KORR-MetaCheck device
  • REE was estimated by bioelectrical impedance analysis using a tetrapolar BIA device and by a Bipolar BIA device
  • Five predictive equations were used for REE estimation:
    • Mifflin
    • World Health Organization/Food and Agriculture Organization/United Nations University
    • Fleisch
    • Horie-Waitzberg and Gonzalez
    • Ireton-Jones.
Independent Variables

Overweight and obese Brazilian men:
  • Anthropometry was assessed while volunteers were standing straight, barefoot and wearing light clothes
  • Body weight was measured to the nearest 0.05kg using a standard microdigital scale
  • Height was measured to the nearest 0.5cm using a vertical wall-mounted stadiometer
  • BMI was calculated by dividing weight in kilograms by height in meters squared. The waist-and-hip circumferences were measured by inelastic tape with accuracy of 1cm.
  • Body composition was assessed by a tetrapolar BIA device.  


Description of Actual Data Sample:
  • Initial N: 48 males
  • Attrition (final N): 48 males
  • Age: Mean age 26.0±5.0 years
  • Ethnicity: Not reported, all Brazilian
  • Other relevant demographics: Mean waist-to-hip ratio 0.91±0.05
  • Anthropometrics: Mean BMI (kg/m2) 29.32±2.62
  • Location: Brazil.


Summary of Results:

Key Findings

  • Most methods showed high agreement with indirect calorimetry as measured using the Deltatrac
  • The highest agreements were found for Mifflin (-2.14%), Fleisch (-3.05%), Horie-Waitzberg and Gonzalez (4.41%) and BIA2 (5.25%). Similar results were shown by the Bland-Altman analyses. 
  • BIA2, followed by BIA1, Ireton-Jones, Mifflin and Fleisch showed the highest association with indirect calorimetry as measured by the Deltatrac
  • The Mifflin, Fleisch, Horie-Waitzberg and Gonzalez equations and BIA2 were the most accurate methods for REE estimation in this study.





Author Conclusion:
This study showed that the bipolar BIA and the Mifflin, Horie-Waitzberg and Gonzalez and Fleisch equations were the most accurate methods for REE estimation in overweight and obese Brazilian men. However, these three equations should be used cautiously in this population because they can lead to a bias when used individually.
Funding Source:
Government: Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)
Reviewer Comments:
   The authors noted that because of sample characteristics, results of this study cannot be generalized to other populations   .
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? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? No
  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? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? No
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? Yes
  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%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? Yes
  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? Yes
  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.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? Yes
  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? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? Yes
  6.6. Were extra or unplanned treatments described? Yes
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? Yes
  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? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? Yes
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? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  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)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  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? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes