Obesity Surgery

, Volume 22, Issue 8, pp 1257–1262 | Cite as

Metabolic Profile of Clinically Severe Obese Patients

  • Silvia Leite FariaEmail author
  • Orlando Pereira Faria
  • Caroline Soares Menezes
  • Heloisa Rodrigues de Gouvêa
  • Mariane de Almeida Cardeal
Clinical Research



Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition.


We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris–Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin–St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables.


Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p < 0.0001). A positive correlation between fat-free mass and a negative correlation between body fat percentage and BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC.


The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.


Clinically severe obesity Indirect calorimetry Energy expenditure Predictive formulas Basal metabolic rate Fat mass Fat-free mass 


Conflict of interest

All authors have no conflict of interest to disclose.


  1. 1.
    Hurt RT, Kulisek C, Buchanan LA, et al. The obesity epidemic: challenges, health initiatives, and implications for gastroenterologists. Gastroenterol Hepatol. 2010;6(12):780–2.Google Scholar
  2. 2.
    WHO. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO; 2003.Google Scholar
  3. 3.
    Wandell PE, Carlsson AC, Theobald H. The association between BMI value and long-term mortality. Int J Obes. 2009;33:577–82.CrossRefGoogle Scholar
  4. 4.
    Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995;332:621–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16:1602–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19:856–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Cunningham JJ. Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation. Am J Clin Nutr. 1991;54:963–9.PubMedGoogle Scholar
  8. 8.
    Feurer ID, Crosby LO, Mullen JL. Measured and predicted resting energy expenditure in clinically stable patients. Clin Nufr. 1984;3:27–34.CrossRefGoogle Scholar
  9. 9.
    Diener JRC. Calorimetria indireta. Rev Assoc Med Bras. 1997;43(3):245–53.PubMedCrossRefGoogle Scholar
  10. 10.
    Foreaux G, Pinto KMC, Dâmaso A. Efeito do consumo excessivo de oxigênio após exercício e da taxa metabólica de repouso no gasto energético. Rev Bras Med Esporte. 2006;12:393–8.CrossRefGoogle Scholar
  11. 11.
    Javed F, He Q, Davidson LE, et al. Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass. Am J Clin Nutr. 2010;91:907–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Mifflin MD. St Jeor ST, Hill LA, et al. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51:241–7.PubMedGoogle Scholar
  13. 13.
    Johnstone AM, Murison SD, Duncan JS, et al. Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine1. Am J Clin Nut. 2005;82:941–8.Google Scholar
  14. 14.
    Lazzer S, Boirie Y, Bitar A, et al. Assessment of energy expenditure associated with physical activities in free-living obese and nonobese adolescents. Am J Clin Nutr. 2003;78:471–9.PubMedGoogle Scholar
  15. 15.
    Nelson KM, Weinsier RL, Long CL, et al. Prediction of resting energy expenditure from fat-free mass and fat mass. Am J Clin Nutr. 1992;56:848–56.PubMedGoogle Scholar
  16. 16.
    Bosy-Westphal A. Grade of adiposity affects the impact of fat mass on resting energy expenditure in women. Br J Nutr. 2009;101:474–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Armellini F, Robbi R, Zamboni M, et al. Resting metabolic rate, body-fat distribution, and visceral fat in obese women. Am J Ch Nutr. 1992;56:981–7.Google Scholar
  18. 18.
    Buffington CK, Cowan Jr GS, Scruggs D, et al. The effects of fat distribution on resting energy expenditure in premenopausal morbidly obese females. Obes Surg. 1995;5:11–7.PubMedCrossRefGoogle Scholar
  19. 19.
    St-Onge MP, Gallagher D. Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. 2010;26(2):152–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Lazzer S, Bedogni G, Lafortuna CL, et al. Relationship between basal metabolic rate, gender, age, and body composition in 8780 white obese subjects. Obesity. 2010;18(1):71–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Dobratz JR, Sibley SD, Beckman TR, et al. Predicting energy expenditure in extremely obese women. J Parent Enteral Nutr. 2007;31(3):217–27.CrossRefGoogle Scholar
  22. 22.
    Breen HB, Ireton-Jones CS. Predicting energy needs in obese patients. Nutr Clin Pract. 2004;19:284–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Hagedorn T, Savina C, Coletti C, et al. Calorimetry in obese women: comparison of two different operating indirect calorimeters together with the predictive equation of Harris and Benedict. Mediterr J Nutr Metab. 2010;4(2):117–25.CrossRefGoogle Scholar
  24. 24.
    Harris JA, Benedict FG. A biometric study of basal metabolism in men. Carnegie Inst. 1919;279(3):48–9.Google Scholar
  25. 25.
    Cunninghan JJ. A reanalysis of the factors influencing basal metabolic rate in normal adults. Am J Clin Nutr. 1980;33:2372–4.Google Scholar
  26. 26.
    Horie LM, Gonzalez MC, Torrinhas RS, et al. New specific equation to estimate resting energy expenditure in severely obese patients. Obesity. 2011;19(5):1090–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Bobbioni-Harsch E, Morel P, Huber O, et al. Energy economy hampers body weight loss after gastric bypass. J Clin Endocrinol Metab. 2000;85:4695–700.PubMedCrossRefGoogle Scholar
  28. 28.
    Astrup A, Gøtzsche PC, Van WK, et al. Meta-analysis of resting metabolic rate in formerly obese subjects. Am J Clin Nutr. 1999;69:1117–22.PubMedGoogle Scholar
  29. 29.
    Ravussin E, Lillioja S, Knowler WC, et al. Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med. 1988;318:467–72.PubMedCrossRefGoogle Scholar
  30. 30.
    Weyer C, Snitker S, Bogardus C, et al. Energy metabolism in African Americans: potential risk factors for obesity. Am J Clin Nutr. 1999;70:13–20.PubMedGoogle Scholar
  31. 31.
    Das K, Saltzman E, McCrory MA, et al. Energy expenditure is very high in extremely obese women. J Nutr. 2004;134:1412–6.PubMedGoogle Scholar
  32. 32.
    Kaiyala KJ, Schwartz MW. Toward a more complete (and less controversial) understanding of energy expenditure and its role in obesity pathogenesis. Diabetes. 2011;60(1):17–23.PubMedCrossRefGoogle Scholar
  33. 33.
    De Lorenzo A, Tagliabue A, Andreoli A, et al. Measured and predicted resting metabolic rate in Italian males and females, aged 18–59 y. Eur J Clin Nutr. 2001;55:208–14.PubMedCrossRefGoogle Scholar
  34. 34.
    Flatt JP. Body composition, respiratory quotient, and weight maintenance. Am J Clin Nutr. 1995;62(5 suppl):1107S–17S.PubMedGoogle Scholar
  35. 35.
    Carrasco F, Papapietro K, Csendes A, et al. Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass. Obes Surg. 2007;17:608–16.PubMedCrossRefGoogle Scholar
  36. 36.
    Frankenfield D, Roth-Yousey L, Compher C. Comparison of predictive equations for resting metabolic rate in healthy nonobese and adults: a systematic review. J Am Diet Assoc. 2005;105:775–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Carrasco F, Rojas P, Ruz M, et al. Agreement between measured and calculated by predictive formulas resting energy expenditure in severe and morbid obese women. Nutr Hosp. 2007;22(4):410–6.PubMedGoogle Scholar
  38. 38.
    Weijs PJ. Validity of predictive equations for resting energy expenditure in US and Dutch overweight and obese class I and II adults aged 18–65 y. Am J Clin Nutr. 2008;88:959–70.PubMedGoogle Scholar
  39. 39.
    Feurer ID, Crosby LO, Buzby GP, et al. Resting energy expenditure in morbid obesity. Ann Surg. 1983;197:17–21.PubMedGoogle Scholar
  40. 40.
    Gougeon R, Lamarche M, Yale J-F, et al. The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia. Int J Obes. 2002;26:1547–55.CrossRefGoogle Scholar
  41. 41.
    Frankenfield DC, Rowe WA, Smith JS, et al. Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc. 2003;103:1152–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Livingston HE, Kohlstadt I. Simplified resting metabolic rate—predicting formulas for normal-sized and obese individuals. Obes Res. 2005;13:1255–62.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • Silvia Leite Faria
    • 1
    Email author
  • Orlando Pereira Faria
    • 1
  • Caroline Soares Menezes
    • 1
  • Heloisa Rodrigues de Gouvêa
    • 1
  • Mariane de Almeida Cardeal
    • 1
  1. 1.Gastrocirurgia de BrasíliaBrasiliaBrazil

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