Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Metabolism and Metabolomics

Total energy expenditure among children with motor, intellectual, visual, and hearing disabilities: a doubly labeled water method

European Journal of Clinical Nutrition volume 75, pages 1607–1617 (2021)Cite this article

Subjects

Abstract

Objective

Few studies have evaluated the total energy expenditure (TEE) of children with disabilities using the doubly labeled water (DLW) method; however, none have compared it by disability type. Furthermore, no large-scale studies have focused on the severity of motor disability (MD). We aimed to compare TEE in children with disabilities by disability type.

Methods

In a cross-sectional study design, TEE was measured using the DLW method, anthropometry, and weighted food records. The following comparisons were made: (1) TEEs among four disability types and (2) TEEs of three subgroups classified by MD based on the Gross Motor Function Classification System (GMFCS).

Results

In total, 256 children (138 boys; ages 6–15 years) were studied. The comparison between the four disability types for boys in all age categories revealed that TEE (kJ/d) was lowest in MD, followed by intellectual disability (ID), visual disability, and hearing disability (HD), in that order. TEE/fat-free mass (FFM) (kJ/FFMkg/d) was also lowest in MD and highest in HD. TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were also lowest in MD and highest in HD in girls. For both boys and girls, TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were higher in the MD subtype GMFCS I–II than in GMFCS III–IV and GMFCS V.

Conclusions

TEE differed, depending on the disability type, and was the lowest in MD and highest in HD for both boys and girls. Analysis by GMFCS classification revealed that greater severity of motor dysfunction resulted in lower TEE.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Schoeller DA. Energy expenditure from doubly labeled water: some fundamental considerations in humans. Am J Clin Nutr 1983;38:999–1005. https://doi.org/10.1093/ajcn/38.6.999

    Article  CAS  PubMed  Google Scholar 

  2. Schoeller DA, Ravussin E, Schutz Y, Acheson KJ, Baertschi P, Jequier E. Energy expenditure by doubly labeled water: validation in humans and proposed calculation. Am J Physiol 1986;250:R823–830. https://doi.org/10.1152/ajpregu.1986.250.5.R823

    Article  CAS  PubMed  Google Scholar 

  3. Speakman JR. The history and theory of the doubly labeled water technique. Am J Clin Nutr. 1998;68:932S–938S. https://doi.org/10.1093/ajcn/68.4.932S

    Article  CAS  PubMed  Google Scholar 

  4. Schoeller DA. Recent advances from application of doubly labeled water to measurement of human energy expenditure. J Nutr. 1999;129:1765–8. https://doi.org/10.1093/jn/129.10.1765

    Article  CAS  PubMed  Google Scholar 

  5. Tabata I, Ebine N, Kawashima Y, Ishikawa-Takata K, Tanaka S, Higuchi M, et al. Dietary reference intakes for Japanese 2010: energy. J Nutr Sci Vitaminol 2013;59:S26–S35. https://doi.org/10.3177/jnsv.59.S26

    Article  CAS  Google Scholar 

  6. Brooks GA, Butte NF, Rand WM, Flatt JP, Caballero B. Chronicle of the Institute of Medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations. Am J Clin Nutr 2004;79:921S–30S. https://doi.org/10.1093/ajcn/79.5.921S

    Article  CAS  PubMed  Google Scholar 

  7. Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington DC: National Academies Press; 2005) p. 107–264

  8. Kuperminc MN, Stevenson RD. Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev. 2008;14:137–46.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Burrows T, Goldman S, Rollo M. A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labelled water. Eur J Clin Nutr. 2019. https://doi.org/10.1016/j.jada.2010.07.008

  10. Walker JL, Ardouin S, Burrows T. The validity of dietary assessment methods to accurately measure energy intake in children and adolescents who are overweight or obese: a systematic review. Eur J Clin Nutr. 2018;72:185–97. https://doi.org/10.1038/s41430-017-0029-2

    Article  PubMed  Google Scholar 

  11. Sardinha LB, Júdice PB. Usefulness of motion sensors to estimate energy expenditure in children and adults: a narrative review of studies using DLW. Eur J Clin Nutr 2017;71:331–9. https://doi.org/10.1038/ejcn.2017.2

    Article  CAS  PubMed  Google Scholar 

  12. Bandini LG, Schoeller DA, Fukagawa NK, Wykes LJ, Dietz WH. Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia. Pediatr Res. 1991;29:70–77. https://doi.org/10.1203/00006450-199101000-00014

    Article  CAS  PubMed  Google Scholar 

  13. Polfuss M, Sawin KJ, Papanek PE, Bandini L. Total energy expenditure and body composition of children with developmental disabilities. Disabil Health J. 2018;11:442–6. https://doi.org/10.1016/j.dhjo.2017.12.009

    Article  PubMed  Google Scholar 

  14. Walker JL, Bell KL, Boyd RN, Davies PS. Validation of a modified three-day weighed food record for measuring energy intake in preschool-aged children with cerebral palsy. Clin Nutr. 2013;32:426–31. https://doi.org/10.1016/j.clnu.2012.09.005

    Article  PubMed  Google Scholar 

  15. Walker JL, Bell KL, Boyd RN, Davies PS. Energy requirements in preschool-age children with cerebral palsy. Am J Clin Nutr. 2012;96:1309–15. https://doi.org/10.3945/ajcn.112.043430

    Article  CAS  PubMed  Google Scholar 

  16. Rieken R, van Goudoever JB, Schierbeek H, Willemsen SP, Calis EA, Tibboel D, et al. Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability. Am J Clin Nutr 2011;94:759–66. https://doi.org/10.3945/ajcn.110.003798

    Article  CAS  PubMed  Google Scholar 

  17. Bell KL, Davies PS. Energy expenditure and physical activity of ambulatory children with cerebral palsy and of typically developing children. Am J Clin Nutr. 2010;92:313–9. https://doi.org/10.3945/ajcn.2010.29388

    Article  CAS  PubMed  Google Scholar 

  18. Stallings VA, Zemel BS, Davies JC, Cronk CE, Charney EB. Energy expenditure of children and adolescents with severe disabilities: a cerebral palsy model. Am J Clin Nutr 1996;64:627–34. https://doi.org/10.1093/ajcn/64.4.627

    Article  CAS  PubMed  Google Scholar 

  19. Sullivan PB, Alder N, Bachlet AM, Grant H. Gastrostomy feeding in cerebral palsy: too much of a good thing? Dev Med Child Neurol 2006;48:877–82. https://doi.org/10.1017/S0012162206001927

    Article  PubMed  Google Scholar 

  20. Luke A, Roizen NJ, Sutton M, Schoeller DA. Energy expenditure in children with Down syndrome: correcting metabolic rate for movement. J Pediatr 1994;125:829–38. https://doi.org/10.1016/S0022-3476(06)80193-9

    Article  CAS  PubMed  Google Scholar 

  21. International Atomic Energy Agency. Assessment of body composition and total energy expenditure in humans using stable isotope techniques. Vienna, Austria: International Atomic Energy Agency; 2009

  22. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214–23. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x

    Article  CAS  PubMed  Google Scholar 

  23. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50:744–50. https://doi.org/10.1111/j.1469-8749.2008.03089.x

    Article  PubMed  Google Scholar 

  24. Ministry of Education, Culture, Sports, Science and Technology. Annual Report of School Health Statistics Research. Tokyo, Japan: Ministry of Education, Culture, Sports, Science and Technology; 2010

  25. Roberts SB, Dietz W, Sharp T, Dallal GE, Hill JO. Multiple laboratory comparison of the doubly labeled water technique. Obes Res. 1995;3:3–13. https://doi.org/10.1002/j.1550-8528.1995.tb00002.x

    Article  PubMed  Google Scholar 

  26. Speakman JR Assumptions in the single model of Lifson and co-workers. In: Doubly Labelled Water. Theory and Practice. London: Chapman & Hall; 1997. p.115–133

  27. Lohman TG. Estimating body composition in children and the elderly. In: Advances in body composition assessment. Illinois: Human Kinetics Publishers; 1992. p. 65–77

  28. Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949;109:1–9. https://doi.org/10.1113/jphysiol.1949.sp004363

    Article  PubMed  PubMed Central  Google Scholar 

  29. Black AE, Prentice AM, Coward WA. Use of food quotients to predict respiratory quotients for the doubly-labelled water method of measuring energy expenditure. Hum Nutr Clin Nutr. 1986;40:381–91

    CAS  PubMed  Google Scholar 

  30. Calis EA, Veugelers R, Rieken R, Tibboel D, Evenhuis HM, Penning C. Energy intake does not correlate with nutritional state in children with severe generalized cerebral palsy and intellectual disability. Clin Nutr. 2010;29:617–21. https://doi.org/10.1016/j.clnu.2010.02.006

    Article  PubMed  Google Scholar 

  31. Wang J, Gao Y, Kwok HHM, Huang WYJ, Li S, Li L. Children with intellectual disability are vulnerable to overweight and obesity: a cross-sectional study among Chinese children. Child Obes. 2018;14:316–26. https://doi.org/10.1089/chi.2018.0015

    Article  PubMed  Google Scholar 

  32. Must A, Curtin C, Hubbard K, Sikich L, Bedford J, Bandini L. Obesity prevention for children with developmental disabilities. Curr Obes Rep. 2014;3:156–70. https://doi.org/10.1007/s13679-014-0098-7

    Article  PubMed  PubMed Central  Google Scholar 

  33. Murray J, Ryan-Krause P. Obesity in children with Down syndrome: background and recommendations for management. Pediatr Nurs. 2010;36:314–9

    PubMed  Google Scholar 

  34. Minister of Health, Labour and Welfare. Dietary reference intakes for Japanese (2015). II Energy and Nutrients. Table 4 The basal metabolism reference values for the reference bodyweight (BW). Tokyo, Japan 2015:45. https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000208955.pdf

  35. Suzuki M, Saitoh S, Tasaki Y, Shimomura Y, Makishima R, Hosoya N. Nutritional status and daily physical activity of handicapped students in Tokyo metropolitan schools for deaf, blind, mentally retarded, and physically handicapped individuals. Am J Clin Nutr. 1991;54:1101–11. https://doi.org/10.1093/ajcn/54.6.1101

    Article  CAS  PubMed  Google Scholar 

  36. Ministry of Education, Culture, Sports, Science and Technology. School feeding standards for kindergarten and high schools of special support schools. 2009. Ministry of Education, Culture, Sports, Science and Technology Notification No. 63. https://www.mext.go.jp/content/1407743_003.pdf

  37. Meyns P, Van Gestel L, Bar-On L, Goudriaan M, Wambacq H, Aertbelien E, et al. Children with spastic cerebral Palsy experience difficulties adjusting their gait pattern to weight added to the waist, while typically developing children do not. Front Hum Neurosci. 2016;10:657 https://doi.org/10.3389/fnhum.2016.00657

    Article  PubMed  PubMed Central  Google Scholar 

  38. Xiao D, Qu Y, Huang L, Wang Y, Li X, Mu D Association between maternal overweight or obesity and cerebral palsy in children: A meta-analysis. PLoS ONE 2018; 13. https://doi.org/10.1371/journal.pone.0205733

Download references

Acknowledgements

We wish to thank the participating children, parents, principal, and staff members of each school who provided help in conducting this research.

Funding

This study was supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology in Japan (to HO). The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Author notes

  1. Kazuko Ishikawa-Takata

    Present address: Faculty of Applied Biosciences, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo, Japan

  2. Shigeho Tanaka

    Present address: Faculty of Nutrition, Kagawa Nutrition University, 3-9-21 Chiyoda, Sakado, Saitama, Japan

Authors and Affiliations

  1. Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, 6-15-1 Torimachi, Yonezawa, Yamagata, Japan

    Hiroko Ohwada & Yuki Kanaya

  2. Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Kyoto, Japan

    Takeo Nakayama

  3. Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan

    Kazuko Ishikawa-Takata & Shigeho Tanaka

  4. Department of Pediatrics, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan

    Nobuaki Iwasaki

Authors
  1. Hiroko Ohwada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeo Nakayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuko Ishikawa-Takata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nobuaki Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuki Kanaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shigeho Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HO designed and conducted the research, analyzed the data, and also wrote the paper. TN designed the research, analyzed the data, and wrote the paper. KIT designed the research, conducted research, and wrote the paper. NI analyzed the data. YK conducted the research. ST designed the research. All authors contributed to data interpretation and read and approved the final manuscript.

Corresponding author

Correspondence to Hiroko Ohwada.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ohwada, H., Nakayama, T., Ishikawa-Takata, K. et al. Total energy expenditure among children with motor, intellectual, visual, and hearing disabilities: a doubly labeled water method. Eur J Clin Nutr 75, 1607–1617 (2021). https://doi.org/10.1038/s41430-021-00885-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-021-00885-7

Search

Advanced search

Quick links