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Table 4 Groups of children, classified by sex and age, whose total daily energy expenditure was estimated by heart rate monitoring methods (does not include 1-3% energy, depending on age, that should be retained for growth)

     

Total energy expenditure

 

Age (y)

n

Weight
(kg)

(kcal/d)

(kcal/kg/d)

PALa

Country

Conditionc

Methodd

Source

Boys

2.5 0.7

6

11.9 1.0

1060

89.1 9.0

1.56b

Guatemala

Stunted

Accum

Torun & Viteri (1981b)

3.1 0.3

11

12.0 0.8

901

74.8 7.6

1.34

Guatemala

Stunted

Accum

Torun & Viteri (1981a)

6.8 0.5

24

21.9 1.6

1581 374

72.3 16.8

1.60

Colombia


M-M

Spurr & Reina (1988a)

7.0 0.5

12

21.8 1.4

1541 255

70.2 8.4

1.54b

Colombia


Accum

Spurr et al (1986)

7.0 0.5

21

19.3 1.7

1207 243

62.7 12.5

1.46

Colombia

Underweight

M-M

Spurr & Reina (1988a)

7.4 0.7

9

19.4 2.3

1502 176

81.0 9.7

1.59b

Colombia

Underweight

Accum

Spurr et al(1986)

7.5 0.3

6

25.4 6.6

1859 388

74.4 12.2

1.64

UK


M-M

Livingstone et al (1992a)

8.4

5

27.8

2414 394

86.8 14.2

2.13b

Holland


M-M

Emons et al(1992)

9.3 0.2

5

30.2 9.4

2119 182

74.5 17.7

1.88

UK


M-M

Livingstone et al (1992a)

9.4 1.0

11

32.1 4.4

2164 199

66.4 9.8

1.86

Canada


Accum

Spady (1980)

10.8 0.5

34

33.3 2.8

2051 400

61.7 13.0

1.75

Guatemala


M-M

Ramirez & Torun (1994)

10.9 0.6

19

25.9 2.6

1918 425

73.6 16.6

1.72b

Colombia

Underweight

Accum

Spurr et al (1986)

11.0 0.6

20

32.4 3.3

2209 419

68.1 12.7

1.79b

Colombia


Accum

Spurr et al (1986)

11.1 0.6

14

33.1 2.3

2009 421

60.7 12.7

1.67

Colombia


M-M

Spurr & Reina (1988b)

11.1 0.6

23

27.2 2.8

1823 513

67.5 17.2

1.74

Colombia

Underweight

M-M

Spurr & Reina (1988a)

11.1 0.6

19

26.6 3.2

1828 378

68.7 14.2

1.77

Colombia

Underweight

M-M

Spurr & Reina (1988b)

11.1 0.5

34

28.8 3.1

2015 379

70.1 11.5

1.83

Guatemala

Stunted

M-M

Ramirez & Torun (1994)

11.2 0.5

18

33.3 2.5

2020 542

60.5 15.2

1.74

Colombia


M-M

Spurr & Reina (1988a)

12.7 0.3

5

43.8 7.3

2624 315

61.4 12.7

1.76

UK


M-M

Livingstone et al (1992a)

14.6 0.6

16

34.8 5.1

2445 493

71.4 12.5

1.92

Colombia

Underweight

Accum

Spurr et al (1986)

14.7 0.5

12

46.7 3.5

2762 480

58.4 9.0

1.84

Colombia


Accum

Spurr et al (1986)

14.8 0.6

20

49.9 3.2

2896 650

58.4 14.4

1.94

Colombia


M-M

Spurr & Reina (1988a)

14.8 0.4

26

38.9 5.3

2556 580

65.6 13.7

1.93

Colombia

Underweight

M-M

Spurr & Reina (1988a)

15.4 0.4

3

50.7 6.4

2745 33

54.7 6.9

1.71

UK


M-M

Livingstone et al (1992a)

Girls

6.6 0.5

21

21.4 1.1

1386 304

63.0 11.5

1.53

Colombia


M-M

Spurr & Reina (1988a)

7.0 0.5

16

18.2 1.7

1244 254

67.6 13.5

1.40

Colombia

Underweight

M-M

Spurr & Reina (1988a)

7.8 0.3

5

23.5 2.5

1609 260

68.3 5.0

1.55

UK


M-M

Livingstone et al (1992a)

8.4

5

28.3

2079 191

73.5 6.8

1.96b

Holland


M-M

Emons et al (1992)

9.4 0.5

4

33.4 3.8

1729 174

52.0 5.2

1.63

UK


M-M

Livingstone et al (1992a)

9.4 1.2

24

28.3 3.4

1537 340

55.2 13.6

1.43

Colombia


Accum

Spurr & Reina (1987)

9.5 0.8

10

31.6 3 7

1716 243

55.1 11.6

1.52b

Canada


Accum

Spady (1980)

9.8 1.0

20

23.7 2.3

1640 284

69.4 10.3

1.70b

Colombia

Underweight

Accum

Spurr & Reina (1987)

10.8 0.6

21

27.3 4.0

1584 369

55.1 12.8

1.57

Colombia

Underweight

M-M

Spurr & Reina (1988a)

10.9 0.7

11

34.2 3.7

1611 319

46.8 8.9

1.45

Colombia


M-M

Spurr & Reina (1988a)

11.4 0.5

23

29.2 3.3

1867 338

63.6 11.6

1.72b

Guatemala

Stunted

M-M

Torun et al (1993)

11.8 0.6

88e

31.1 4.0

2013 400

64.3 11.8

1.81b

Guatemala

Stunted

M-M

Torun et al (1993)

12.2 0.5

21

33.7 4.4

2170 441

64.5 11.5

1.90b

Guatemala

Stunted

M-M

Torun et al (1993)

12.5 0.4

5

45.1 4.7

2232 234

49.7 5.4

1.60

UK


M-M

Livingstone et al (1992a)

14.9 0.6

19

49.3 2.7

1982 452

41.7 9.6

1.61

Colombia


M-M

Spurr & Reina (1988a)

15.2 0.5

22

42.0 4.1

1950 585

48.6 14.9

1.61

Colombia

Underweight

M-M

Spurr & Reina (1988a)

15.6 0.4

3

55.4 13.2

2365 811

42.9 12.3

1.88

UK


M-M

Livingstone et al (1992a)

a Physical Activity Level calculated using BMR measured by the investigators or estimated mathematically (b).
b PAL calculated using BMR estimated with Schofield's equations (1985).
c Stunted: > 1.5 s.d. below the NCHS median of height-for-age. Underweight: < 95% of weight-for-age and weight-for-height in comparison to Colombian children of upper socioeconomic groups (Rueda-Williamson et al, 1969). All others: adequate height and weight for age.
d Accum = heart rate accumulation during daytime, and BMR while sleeping; M - M = minute-by-minute recording.
e 22 girls measured longitudinally four times at 3-month intervals.

Table 5 Mean physical activity levels of children in Table 4 grouped by age, sex and height or weight. (Total energy expenditure estimated by heart rate monitoring; BMR's were measured or estimated with Schofield's equations)a

Age (years)

Boys

Girls

Adequate
wt and ht

Stunted or underweight

All

Adequate
wt and ht

Stunted or underweight

All

(A) Means of mean values in each studyb

2-3

-

1.45 (2)

-

-

-

-

6-13

1.72 0.11 (10)b

1.68 0.14 (6)

1.71 0.12 (16)

1.53 0.07 (7)

1.66 0.19 (5)

1.58 0.14 (12)

14+

1.83 0.12 (3)

1.92 (2)

1.87 0.10 (5)

1.74 (2)

1.61 (1)

1.70 0.16 (3)

(B) Weighted meansc

2-3

-

1.42 (17)

-

-

-

-

6-13

1.65 (149)

1.71 (125)

1.68 (274)

1.50 (80)

1.67 (101)

1.60 (181)

14+

1.89 (35)

1.93 (42)

1.91 (77)

1.65 (22)

1.61 (22)

1.63 (44)

a Data of Emons et al (1992) excluded due to their unusually high PAL's.
b Mean s.d. of mean values in Table 4. Number of data sets in parenthesis.
c Weighted by the number of children in each study (in parenthesis)

PALs in Table 4 were calculated using measured BMR in most studies; estimates with Schofield's equations (1985) were used in only six of them. Table 5 shows the mean PALs for the same age groups as in Table 3. Although there were large differences in sample sizes (3-34), the means of the mean values in each study were within 5% of the mean values weighted for the number of children in every sex-and-age group.

All Canadian, Dutch and Irish children apparently had adequate weight and height. The Colombian children were from low and low-middle socioeconomic groups of Cali. They were classified as well nourished or as marginally malnourished or underweight when their weight-for-age and weight-for-height was above or below 95% of the Colombian standards for children of upper socioeconomic groups, respectively (Rueda-Williamson et al, 1969). Most Guatemalan children were from the lower socioeconomic groups of Guatemala City. While presently well nourished, they were stunted by more than 1.5 s.d. below the NCHS/WHO median of height-for-age. One group of Guatemalan boys (Ramirez and Torun, 1994) was from the middle socioeconomic class and they had adequate height and weight.

Figure 2 compares the data in Table 4, expressed as kcal/kg/day, with the FAO/WHO/UNU 1985 recommendations. Total energy expenditure per unit of body weight was greater among the stunted and underweight children. Since the FAO/WHO/UNU values were derived from data of well nourished, non-stunted children, Figure 3 shows only the values described in Table 4 for such children. They are combined with data from doubly-labeled water in Figure 4.

The higher energy expenditure per unit of body weight often observed in stunted and mildly malnourished children, compared with those of adequate height and weight (Tables 1 and 4), could be partly due to differences in body composition. If so, the differences in TEE would be expected to decrease or disappear when expressed as multiples of BMR (i.e. PAL units). Table 6 shows the PALs of 'normal' and stunted or mildly underweight individuals within the same community. In contrast with TEE per unit of body weight, there was no consistent difference in the PAL of children and adolescents with adequate height and weight, compared with their stunted or slightly underweight counterparts (Tables 5 and 6). This supports the explanation attributing differences to body composition.

However, the differences in TEE could also be related to the children's physical activity patterns. An examination of the minute-by-minute heart rate and its energy equivalence in Guatemalan school-boys of different height and socioeconomic status, showed that during the active hours of the day, the stunted (low income) group spent less time than the taller (middle income) group in 'sedentary' activities (434 160 vs 566 159 min. P < 0.01) and more time in 'light' activities that demanded some degree of physical effort (213 136 vs 103 94 minutes/day, P < 0.01) (Ramirez and Torun, 1994). This was probably due to the different lifestyles imposed by the different socioeconomic conditions of the two groups of children.

Figure 2a Total energy expenditure estimated by heart rate monitoring: boys.

Figure 2a Total energy expenditure estimated by heart rate monitoring: girls.

Continued


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