European Journal of Clinical Nutrition (2006) 60, 1258–1265
& 2006 Nature Publishing Group All rights reserved 0954-3007/06 $30.00
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ORIGINAL ARTICLE
Total energy expenditure, resting metabolic rate
and physical activity level in free-living rural elderly
men and women from Cuba, Chile and México
H Alemán-Mateo1, G Salazar2, M Hernández-Triana2,3 and ME Valencia1
1
Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, AC (CIAD, AC), Hermosillo, Sonora, México;
Laboratorio de Metabolismo Energético e Isótopos Estables, Área de Nutrición Pública, Instituto de Nutrición y Tecnologı´a de los
Alimentos (INTA), Universidad de Chile, Santiago, Chile and 3Departamento de Bioquı´mica y Fisiologı´a, Instituto de Nutrición e
Higiene de los Alimentos (INHA), La Habana, Cuba
2
Objective: The objective of this study was to assess total energy expenditure (TEE), resting metabolic rate (RMR) and physical
activity level (PAL), and to estimate energy requirements (ERs) in free-living elderly subjects from Cuba, Chile and Mexico.
Design: Cross-sectional study designed to estimate ERs.
Setting: Rural regions of Cuba, Chile and Mexico.
Subjects: Forty subjects 460 years old were selected to participate in this study.
Interventions: A dose of doubly labeled water (DLW) was administered and urine samples were collected in the following 12–14
days. From the isotopic analysis, TEE was derived. RMR was measured by indirect calorimetry.
Results: TEE in Chilean (8.871.6 MJ/day) and Cuban (8.371.3 MJ/day) elderly was not different, and was higher for the
Mexican group (9.571.5 MJ/day) (Po0.0001). RMR was not different between countries. PAL and activity energy expenditure
(AEE) were only different between Chile and Mexico (Po0.002). For the three regions, overall PALs were 1.7070.16 for male
and 1.6270.13 for female subjects (Po0.02), and AEE was 3.0570.66 and 2.2770.66 MJ/day for male and female subjects,
respectively (Po0.001). Predictive equations (MJ/day) were RMR ¼ 1.6447 þ 0.05714 weight (kg) þ 0.449 sex (male ¼ 1;
female ¼ 0) (R2 ¼ 0.75; SEE ¼ 0.479) and TEE ¼ 3.414 þ 0.0795 weight (kg) þ 1.227 sex (male ¼ 1; female ¼ 0) (R2 ¼ 0.75;
SEE ¼ 0.668).
Conclusions: There were differences in TEE and PAL owing to sex and region. The average PAL in men was higher than the PAL
reported either with factorial approach or with the DLW method in elderly. Predictive ER equations based on RMR and TEE gave
very similar results to calculations from the 2004 FAO/WHO/UNU report.
Sponsorships: The study was funded by CONACYT, Mexico (25728-M).
European Journal of Clinical Nutrition (2006) 60, 1258–1265. doi:10.1038/sj.ejcn.1602446; published online 24 May 2006
Keywords: energy requirements; DLW; elderly; rural; developing countries
Introduction
Correspondence: Dr H Alemán-Mateo, Coordinación de Nutrición, Centro de
Investigación en Alimentación y Desarrollo, AC, (CIAD, AC), Carretera a la
Victoria Km. 0.6, Hermosillo, Sonora, Apartado Postal 1735, CP 83000,
México.
E-mail: [email protected]
Guarantor: ME Valencia.
Contributors: HA-M: Design, field work, data collection, analysis and writing.
GS: Isotope analysis, field work coordination in Chile and data analysis. MHT:
Field work coordination in Cuba and analysis of data and writing. MEV: Project
leader, design, general coordination, analysis and writing of manuscript. None
of the contributing authors had any financial or personal interests in any of the
bodies sponsoring this research.
Received 7 July 2005; revised 31 January 2006; accepted 2 March 2006;
published online 24 May 2006
According to the International Dietary Energy Consultative
Group (IDECG) 1994 and 1999, no data were available on
energy requirements (ERs) and physical activity level (PAL)
for older individuals from developing countries (Dupont
et al., 1996; Beaufrere et al., 2000). Such information is
necessary to define ER recommendations in order to improve
the nutrition and health status of the elderly living in lowincome countries.
ER is the amount of food energy needed to balance energy
expenditure in order to maintain body size, body composition and a level of necessary and desirable physical activity
PAL in Latin American elderly
H Alemán-Mateo et al
1259
consistent with long-term good health (FAO/WHO/UNU,
1985, 2004). In 1981, a group of experts estimated a PAL of
1.51 as an adequate daily energy intake to match daily
energy expenditure (FAO/WHO/UNU, 1985). PAL is recognized as a convenient approach to categorize energy needs,
and allows accounting for body mass differences among
individual by considering resting metabolic rate (RMR)
(Starling and Poehlman, 2000). Nowadays, it is well
recognized that the use of the doubly labeled water (DLW)
method to measure ERs is based on the rationale that total
daily energy expenditure defines the level of metabolizable
intake required to maintain a state of energy balance
(Starling and Poehlman, 2000). In 1994, the IDECG reexamined and updated selected parts of the 1985 technical
report (Dupont et al., 1996). In this workshop, Roberts (1996)
presented the results from 74 healthy subjects and concluded that the ERs of older individuals may be higher than
the ones recommended by FAO/WHO/UNU (1985).
In the 1999 IDECG workshop (Beaufrere et al., 2000), Elia
et al. (2000) presented a position paper based on Roberts
(1996), as well as on new studies. PAL reported for men and
women was similar to that reported by Roberts (1996). These
findings were also confirmed by Starling et al. (1998) for
women but not for men. The mean PAL for elderly men was
higher than indicated by the 1985 FAO/WHO/UNU report
(FAO/WHO/UNU, 1985), Roberts (1996) and Elia et al. (2000).
Few studies have collected information in rural healthy
elderly, with probably different physical activity pattern and
PAL. Seale et al. (2002) reported data of energy expenditure
measured by DLW method in rural elderly men and women
from Pennsylvania, USA. Considering both total energy
expenditure (TEE) and RMR, the mean PAL calculated for
men and women was 1.83 and 1.82, respectively. PAL was
higher than the current recommendations and data reported
in urban healthy elderly. This information indicates that
rural healthy elderly may be more active than the urban
ones. It is well recognized that some elderly subjects are able
to maintain high levels of energy expenditure, with PAL
values as high as 2.48 (Reilly et al., 1993; Withers et al., 1998).
This indicates that their ERs depend on individual, social and
cultural features that promote or limit habitual physical
activity among older people. These studies clearly show that
PAL in the elderly may well be above 1.51, but none of the
cited studies has been carried out in urban or rural settings of
developing countries. There is a great need of PALs in elderly
people from these regions to elucidate whether these
findings can be applied in both rural and urban elderly from
low-income countries. The objective of this study was to
assess TEE, RMR and PAL, and to estimate ERs in free-living
elderly subjects from Cuba, Chile and Mexico.
Subjects and methods
This was a cross-sectional study in rural areas of Cuba, Chile
and Mexico, during spring and summer of 1998–2000.
Initially, the study included 133 free-living subjects, whose
body composition was determined by deuterium dilution
(Valencia et al., 2003). Of these, 40 subjects accepted to
participate in the energy expenditure section. Proper
randomization and representative sampling is difficult to
achieve in DLW studies owing to the high cost of oxygen-18
and mass spectrometry analysis. However, care was taken to
include healthy subjects, in good mental status (Pfeiffer,
1975), physical independency (Katz et al., 1970) and the
willingness to participate.
Ten subjects (five men and five women) from Las Terrazas,
Candelaria Pinar del Rı́o, Cuba; sixteen (eight men and eight
women) from the Municipality of Paine, Chile; and fourteen
(six men and eight women) from El Tazajal and San Pedro el
Saucito, in Sonora, Mexico were included in DLW study.
They were carrying out their habitual daily activities under
free-living conditions in their rural communities. Subjects
were healthy and had no history of coronary heart disease,
hypertension, type II diabetes, arthritis, anemia and recent
loss of weight. With respect to health status and in order to
ensure that subjects were healthy, a general examination was
conducted, as well as urine analysis and an oral glucose
tolerance test to exclude diabetic subjects. Additionally,
none of the subjects were using interfering medications.
RMR, anthropometry and body composition measurements
were performed in the morning between 0700 and 0900 after
a minimum of 10-h fast. Subjects were informed about the
study and signed the consent forms complying with the
regulations of the Ethical Committee from each participating institution (in Cuba, INHA, La Habana; in Chile, INTA,
Universidad de Chile, Santiago; and in México, CIAD, AC,
Hermosillo, Sonora).
In Mexico, body weight was measured with a digital
electronic scale of 15070.05 kg capacity (ADN FV-150K,
Japan) and standing height by a Holtain stadiometer of
20570.1 cm capacity (Holtain Ltd, Dyfed, UK). In Chile,
weight was measured with a SECA scale of 15070.1 kg
capacity and standing height by a SECA stadiometer
(Modern Measurement Devices, San Antonio, TX, USA). In
Cuba, weight was measured by a digital electronic scale of
15070.1 kg capacity (Soehnle, Soehnle-Frères SA, Duppigheim) and standing height by a Holtain Anthropometer
(Holtain Ltd, Dyfed, UK). Weight measurements were
performed in the morning, with subjects under fasting
condition and dressed in a bathing suit. Height was recorded
in all subjects in a standing position after removing the
shoes. Body mass index (BMI) (kg/m2) was calculated based
on weight and standing height. Waist circumference was
measured in the supine position at the umbilicus level, using
a fiber glass measuring tape (Lafayette Instruments Company
Inc., USA) and hip circumference was measured in a standing
position at the level of the most prominent part of the
gluteus (Fox et al., 1999). Waist/hip ratio (WHR) was
determined from these measurements. Also, blood pressure
was measured in the sitting position on the right arm using
a mercury column sphygmomanometer. Readings were
European Journal of Clinical Nutrition
PAL in Latin American elderly
H Alemán-Mateo et al
1260
recorded to the nearest even number, and the mean of two
recordings 3 min apart was computed.
In the three countries, body composition was assessed by
bioimpedance analysis (Model BIA-101, RJL Systems, Detroit,
MI, USA) as reported previously and using a predicted
equation generated and validated for Mexican, Chilean and
Cuban elderly subjects (Valencia et al., 2003). Fat-free mass
(FFM) was also determined from total body water (TBW)
measurements, calculated from the average of the deuterium
(2H) and oxygen-18 (18O) dilution spaces from the measurements of energy expenditure. TBW was corrected by 4% for
the sequestration of 2H into labile sites in protein and 1% for
the sequestration of 18O. FFM was obtained from the
relationship of TBW/0.734 (Schoeller, 1996).
RMR measurements were performed under standard conditions of immobility, fasting state (for at least 10 h before
tests), thermoneutral environment (23–261C) and at 45–60%
relative humidity. It was measured by ventilated hood
indirect calorimetry using a Deltatrac metabolic monitor
(Datex Intr., Helsinky, Finland). A transparent, plastic hood
was used to collect the expired air for 20 min after a 5 min
equilibration period. The Deltatrac was calibrated before
each run with a span gas mixture of O2–CO2 (95.94:4.06,
v/v). Atmospheric pressure was set according to a mercury
barometer (Princo, PA, USA). The Deltatrac system was
regularly checked by measuring the gas production during
absolute ethanol burns (Merck-México, SA, Edo. Mex.
Mexico) at a rate within the range of the energy expenditure
measurements of the subjects. Calibration gas burns for the
Deltatrac were in the range 3.8–7.9 MJ/day. Alcohol combustion burns were performed at all sites. Gas recoveries were on
average 97.7 and 102% for CO2 and O2, respectively, and
measured respiratory quotient (RQ) ¼ 0.65 versus an expected value of 0.667. RMR was calculated from VO2 and
VCO2 measured values applying Weir equation (Weir, 1949).
Predicted RMR based on body weight was estimated from the
equations proposed by Schofield and recommended by the
Expert Committee on Energy from FAO/WHO/UNU (2004).
TEE was assessed using the DLW methodology for a period
of 11–13 days. In Cuban, Chilean and Mexican elderly, the
dose was administered after an overnight fast, including
0.05, 0.07 and 0.05 g/kg body weight of 2 h (99.9% enrichment, Icon Isotopes, Summit, NJ, USA), respectively. 18O
(10.4% enrichment) was dosed at 1.0, 1.2 and 1.0 g/kg body
weight, respectively (Cortec, Paris, France). A rinse of 30 ml
of water was given to ensure full ingestion of the DLW dose.
Urine samples were collected daily at time zero (basal) and in
the following 14 days. All samples were collected in the
morning (discarding the first urine) and the time of void was
registered; then, samples were stored at 201C until analysis.
Isotopic analysis of samples was performed in triplicate in
a continuous flow mass spectrometer (Hydra, Europe
Scientific, Crewe, UK). Firstly, centrifuged urine samples
(0.4 ml) were equilibrated for 2H, using platinum on alumina
powder (5%) as a catalyst plus the incorporation of pure
hydrogen gas (99.99%). Samples were left at room temperaEuropean Journal of Clinical Nutrition
ture (201C) near the mass spectrometer for 3 days in order to
allow equilibration. In the case of 18O, the same amount of
urine was used, but 4% CO2 gas was influxed and samples
were left to equilibrate overnight in a bath at 251C under
continuous shaking. Internal precision during the mass
spectrometry measurements was checked by including
reference standards in the run; precision was 2–3 deltas
(B0.3–0.5 p.p.m.) for 2H and 0.5 deltas (B0.25 p.p.m.) for
18
O analysis.
TEE was obtained according to Coward et al. (1988)
multipoint procedure, which allowed the calculation of
average CO2 production (within 12–14 days) and the
inference of compound total error in CO2 production. In
every subject, CO2 production was obtained from the
difference in 18O and 2H disappearance rate and was
corrected by the error introduced by isotopic background
variability, fractionation effects and residual contribution
error from the experimental and analytical methods. Final
CO2 production was transformed to energy by utilizing
Weir’s equation (1949), which includes food quotient (FQ)
value as a proxy to RQ (Weir, 1949; Black et al., 1986).
Individual FQ was obtained from 24 h recall dietary records
for the Mexican group (FQ ¼ 88.4) using Lusk’s equation
(1928). In Cubans, a 7-day weighed record was used to
calculate the FQ of 89.8. For the Chilean group, the FQ of
90.2 was obtained from two published dietary studies (Gattas
et al., 1999; Labraña et al., 1999) based upon 24 h dietary
recall data. The estimation of ERs, expressed as total daily
energy expenditure and RMR for the whole group (three
countries), was derived from a multiple regression equation.
Indices of physical activity were calculated as follows.
Physical activity was evaluated as PAL ¼ TEE/RMR and
activity energy expenditure as AEE ¼ TEE(RMR þ 0.1 TEE),
where 0.1 TEE represents diet-induced thermogenesis
(Schutz et al., 1984). Also, TEE was adjusted for RMR and
AEE was adjusted for FFM. These variables were considered
additional expressions of physical activity (Esparza et al.,
2000). Additionally, a modified questionnaire, designed and
validated by Kriska et al. (1990) adapted by Alemán et al.
(1999), was used to establish the physical activity pattern.
Data were analyzed using the statistical program NCSS
2001 (Number Cruncher Statistical System for Windows,
Kaysville, UT, USA). Descriptive statistics were calculated for
some physical characteristics as sex-specific group using a
two-sample t test. Results are expressed as mean7standard
deviation (s.d.). A two-way analysis of variance was used to
determine differences between countries and sex for predicted and measured RMR, TEE, PAL and AEE. Duncan
multiple range test was used to compare by country. Results
are expressed as mean7s.d. Comparison of TEE value
between countries was performed after adjusting for RMR
and FFM using covariance analysis; AEE was adjusted for FFM
using the same procedure. Results are expressed as mean7
standard error. Equations were obtained by the stepwise
multiple regression procedure. Variables considered for
establishing the models included body weight (kg), FFM
PAL in Latin American elderly
H Alemán-Mateo et al
1261
(kg), height (cm), age (years), sex (male ¼ 1; female ¼ 0) and
ethnicity or country (Chile ¼ 1, Cuba ¼ 2 and Mexico ¼ 3).
Results
Table 1 shows some of the physical, metabolic and body
composition characteristics of subjects who ranged in age
from 60 to 83 years. Men and women were similar in age,
BMI, waist, hip, WHR and systolic and diastolic blood
pressure. Men were significantly heavier (Po0.05), taller
and had higher FFM and less fat mass than women
(Po0.0001).
In absolute terms, energy expenditure was as follows.
Measured RMR was 1 MJ/day higher in men than in women
(Po0.0001), but there were no differences by country
(Table 2). Measured and predicted RMR for the whole group
was 5.41 and 5.37 MJ/day, respectively (P ¼ 0.60). With
respect to TEE by country, the results showed that Chilean
Table 1
Subjects characteristics
Age (years)
Weight (kg)
Height (cm)
BMI (kg/m2)
Waist (cm)
Hip (cm)
WHR
SBP (mm Hg)
DBP (mm Hg)
FFM by 2H18
2 O (kg)
Fat mass by 2H18
2 O (kg)
FFM by BIA (kg)
Fat mass by BIA (kg)
Male (n ¼ 19)
Female (n ¼ 21)
70.175.4
65.9713
16475.7
24.374.2
86.479.9
92.479.1
0.9470.1
134717
79.278.8
47.878.7
18.175.4
48.576.7
17.475.5
69.977.5
57.679.8a
15375.7b
24.773.6
84.3712
93.6711
0.9070.1
126715
74.278.6
36.376.1b
21.475.8
36.475.4b
21.276.7b
Abbreviations: BIA, bioelectrical impedance analysis; BMI, body mass index;
DBP, diastolic blood pressure; FFM, fat-free mass; SBP, systolic blood pressure;
WHR, waist/hip ratio.
Values are mean7s.d.
a
Significantly different from male subjects: Po0.05.
b
Significantly different from male subjects: Po0.0001.
Table 2 Energy expenditure and physical activity in elderly subjects by gender and country
Chile
Males
No.
No.
No.
No.
No.
No.
No.
No.
1
2
3
4
5
6
7
8
Females
No. 1
No. 2
No. 3
No. 4
No. 5
No. 6
No. 7
No. 8
Mean7s.d.
Cuba
Males
No.
No.
No.
No.
No.
1
2
3
4
5
Females
No. 1
No. 2
No. 3
No. 4
No. 5
Mean7s.d.
Height (cm)
Body weight (kg)
pRMR (MJ/day)
mRMR (MJ/day)
TEE (MJ/day)
Space ratio
PAL
AEE (MJ/day)
165
159
155
171
153
166
165
164
84.1
65.3
42.3
87.7
52.7
79.3
80.7
67.9
6.79
5.72
4.42
6.99
5.01
6.51
6.59
5.87
6.56
5.80
4.43
7.90
5.14
6.29
6.83
6.80
10.02
9.60
8.70
11.24
8.46
9.35
12.42
10.05
1.058
1.040
1.014
1.011
1.013
1.024
1.048
1.030
1.53
1.66
1.96
1.42
1.65
1.49
1.82
1.48
2.46
2.84
3.40
2.21
2.47
2.13
4.35
2.25
148
150
149
148
148
155
155
144
15678.1a
57.2
56.0
60.2
54.0
43.6
58.7
62.9
56.3
63.1713.7
5.01
4.96
5.14
4.87
4.41
5.07
5.26
4.97
5.570.8
5.78
4.33
4.68
4.99
4.15
5.15
4.66
6.00
5.671.1
8.45
6.78
7.60
8.04
6.11
8.77
6.95
8.26
8.871.6
1.013
1.024
1.054
1.028
1.014
1.046
1.014
1.010
1.02870.016
1.46
1.57
1.62
1.61
1.47
1.70
1.49
1.39
1.5870.15
1.83
1.77
2.16
2.24
1.35
2.74
1.60
1.44
2.3270.75
162
169
159
169
158
53.4
65.5
52.8
62.1
45.0
5.05
5.74
5.02
5.55
4.58
5.25
6.01
5.28
6.05
4.29
9.82
9.22
8.88
10.63
8.33
1.056
1.010
1.010
1.036
1.050
1.87
1.53
1.68
1.76
1.94
3.59
2.29
2.71
3.52
3.21
157
151
156
147
151
15877.5
41.7
49.7
63.3
61.8
37.5
53.379.8b
4.33
4.68
5.27
5.21
4.14
4.970.5c
4.98
4.79
4.56
5.24
3.81
5.070.7
7.36
7.76
7.71
7.61
6.06
8.371.3
1.022
1.062
1.036
1.033
1.024
1.03370.018
1.48
1.62
1.69
1.45
1.59
1.6670.16
1.64
2.19
2.38
1.60
1.64
2.4770.76
European Journal of Clinical Nutrition
PAL in Latin American elderly
H Alemán-Mateo et al
1262
Table 2 Continued
Mexico
Males
No.
No.
No.
No.
No.
No.
1
2
3
4
5
6
Females
No. 1
No. 2
No. 3
No. 4
No. 5
No. 6
No. 7
No. 8
Mean7s.d.
Sex
Male (Mean7s.d.)
Female (Mean7s.d.)
Height (cm)
Body weight (kg)
pRMR (MJ/day)
mRMR (MJ/day)
TEE (MJ/day)
Space ratio
PAL
AEE (MJ/day)
168
168
163
172
174
163
71.5
81.6
68.5
56.9
66.5
68.9
6.08
6.65
5.91
5.25
5.79
5.93
6.15
7.17
5.25
5.25
6.02
5.77
10.53
11.84
9.51
8.91
10.41
11.13
1.015
1.039
1.046
1.051
1.040
1.025
1.71
1.65
1.81
1.70
1.73
1.93
3.33
3.49
3.30
2.77
3.34
4.25
156
157
157
156
144
164
149
164
16178.4
63.9
63.5
75.2
69.5
51.7
70.3
46.7
65.8
65.879.1
5.30
5.28
5.80
5.55
4.76
5.58
4.55
5.38
5.670.5
4.76
5.22
5.94
5.55
4.15
6.44
3.99
5.00
5.570.9
7.79
9.02
10.48
10.14
7.53
10.62
6.77
8.81
9.571.5d
1.010
1.049
1.045
1.037
1.016
1.049
1.018
1.038
1.03470.014
1.64
1.73
1.76
1.83
1.82
1.65
1.70
1.76
1.7470.08e
2.25
2.89
3.49
3.58
2.63
3.12
2.10
2.93
3.1170.56f
16475.7g
15375.7
65.9713.1h
57.679.8
5.7670.74i
5.0270.43
5.9170.91i
4.9670.70
9.9571.15j
8.0371.28
1.03270.016
1.03070.015
1.7070.16k
1.6270.13
3.0570.66j
2.2770.66
Abbreviations: AEE, activity energy expenditure; mRMR, measured resting metabolic rate; PAL, physical activity level; pRMR, predicted resting metabolic rate; s.d.,
standard deviation; TEE, total energy expenditure.
a
Significantly different from Mexico: Po0.01.
b
Significantly different from Chile and Mexico: Po 0.01.
c
Significantly different from Chile and Mexico: Po0.001.
d
Significantly different from Cuba and Chile: Po0.01.
e
Significantly different from Chile: Po0.01.
f
Significantly different from Chile: Po0.01.
g
Significantly different from female (two-way ANOVA): Po0.0001.
h
Significantly different from female (two-way ANOVA): Po0.02.
i
Significantly different from female (two-way ANOVA): Po0.001.
j
Significantly different from female (two-way ANOVA): Po0.001.
k
Significantly different from female (two-way ANOVA): Po0.02.
(8.871.6 MJ/day) and Cuban elderly (8.371.3 MJ/day) had
similar values of TEE, but Mexicans had higher (9.571.5 MJ/
day) (Po0.001). However, when TEE was adjusted for FFM,
differences by country no longer held (Table 3). Figures 1
and 2 show the relationship between TEE and RMR by DLW
as a function of body weight in the three groups.
Physical activity evaluated as PAL and as AEE was different
by sex and country (Table 2). However, it was the Chilean
group that had the lowest mean PAL (1.5870.15) and AEE
(2.3270.75 MJ/day) compared to the Mexican elderly group
who had the highest levels of activity, with a PAL of
1.7470.08 and an AEE of 3.1170.56 MJ/day (Po0.002)
(Table 2). AEE was also adjusted for FFM and the differences
remained for Chile and Mexico with 2.3170.16 and
3.0370.15 MJ/day, respectively (Po0.007). Further, another
indicator of physical activity evaluated, TEE adjusted for
RMR, showed similar results, with 8.5470.18 and
9.4470.19 MJ/day for Chile and Mexico, respectively
(Po0.006) (Table 3). PAL measured by DLW and indirect
calorimetry compared to PAL recommended by WHO/FAO/
European Journal of Clinical Nutrition
Table 3 Physical activity parameters in Cuban, Chilean and Mexican
elderly subjects
TEEFFM (MJ/day)
TEERMR (MJ/day)
AEEFFM (MJ/day)
Chile (eight
males/eight
females)
Cuba (five
males/five
females)
Mexico (six
males/eight
females)
8.7570.21
8.5470.18
2.3170.15
8.7370.27
8.8970.23
2.5970.19
9.3170.22
9.4470.19a
3.0370.16b
Abbreviations: AEE, activity energy expenditure; AEEFFM, AEE adjusted for FFM;
FFM, fat-free mass; RMR, resting metabolic rate; TEE, total energy expenditure; TEEFFM, total energy expenditure adjusted for FFM; TEERMR, TEE adjusted
for RMR.
Mean7s.e.
a
Po0.0001 for Mexico and Chile.
b
Po0.0001 for Mexico and Chile.
UNU (1985) was higher (Po0.001) for Cuban and Mexican
elderly, but not for the Chilean group. Most importantly,
the average values of PAL for men and women were similar
to those reported in the latest FAO/WHO/UNU Expert
PAL in Latin American elderly
H Alemán-Mateo et al
1263
Consultation Report on Human Energy Requirements
(2004).
Predictive equations for RMR and TEE were independently
generated for all subjects from the three countries. Independent variables considered for establishing the ER models
included body weight (kg), FFM (kg), standing height (cm),
age, sex and ethnicity (Chilean, Cuban or Mexican). Table 4
shows RMR and TEE for all subjects expressed as MJ/day and
kcal/day. Even though there were differences in TEE, body
weight and physical activity in the three groups, ethnicity or
country as a variable did not have a significant contribution
to the models and was not included. Age was not included in
spite of a 23-year age range.
older adults and the elderly should be calculated on the basis
of PALs, just as they are calculated for younger adults and
consequently, the accuracy with which basal metabolic rate
(BMR) or RMR is estimated becomes of primary importance.
In this sense, it is equally important to measure it correctly.
In our study, measured and predicted RMR values for the
whole group were not different.
The results of the study of TEE by DLW method in elderly
individuals under free-living conditions from rural areas of
Latin America showed that women had lower TEE than men.
The lower total ERs in older women could be explained by
their lower RMR and physical AEE compared to that of men.
The differences in AEE were 0.78 MJ/day, and in the RMR
were almost 1 MJ/day.
Discussion
According to the FAO/WHO/UNU Expert Consultation
Report on Human Energy Requirements (2004), ERs for
Resting metabolic rate (MJ/d)
Total energy expenditure (MJ/d)
13
8
11
9
6
6
5
3
30
50
70
Body weight (kg)
90
Figure 1 TEE as a function of body weight by country; Cuba
(n ¼ 14, ’), Chile (n ¼ 16, K) or México (n ¼ 10, n) (r ¼ 0.7664;
Po0.0001).
30
50
70
Body weight (kg)
90
Figure 2 RMR as a function of body weight by country; Cuba
(n ¼ 14, ’), Chile (n ¼ 16, K) or México (n ¼ 10, n) (r ¼ 0.8306;
Po0.0001).
Table 4 Predictive equations of RMR and TEE in Chilean, Cuban and Mexican men and women (n ¼ 40)
Equation
R2
SEE
RMR
Equation 1 (kcal/day)a
Equation 2 (MJ/day)b
RMR ¼ 394.1 þ (13.64 weight) þ (107.7 sex)
RMR ¼ 1.6447 þ (0.05714 weight) þ (0.449 sex)
0.75
0.75
114
0.479
TEE
Equation 3 (kcal/day)c
Equation 4 (MJ/day)d
TEE ¼ 815.5 þ (19.015 weight) þ (293.5 sex)
TEE ¼ 3.414 þ (0.0795 weight) þ (1.227 sex)
0.73
0.73
195.5
0.668
Abbreviations: RMR, resting metabolic rate; TEE, total energy expenditure.
Independent variables considered for establishing the energy requirement models included body weight (kg), fat-free mass (kg), standing height (cm), age (years),
sex (male ¼ 1; female ¼ 0) and ethnicity or country of origin (Chile ¼ 1; Mexico ¼ 2; Cuba ¼ 3).
P-values were o0.0001 for all b coefficients.
a
The s.e.m. (kcal/day) of the b coefficients were 97.4 (intercept), 1.62 (weight), 38.9 (sex).
b
The s.e.m. (MJ/day) of the b coefficients were 0.408 (intercept), 0.007 (weight), 0.163 (sex).
c
The s.e.m. (kcal/day) of the b coefficients were 166 (intercept), 2.76 (weight), 66.4 (sex).
d
The s.e.m. (MJ/day) of the b coefficients were 0.695 (intercept), 0.12 (weight), 0.278 (sex).
European Journal of Clinical Nutrition
PAL in Latin American elderly
H Alemán-Mateo et al
1264
This study included elderly from three different countries
and ethnic backgrounds – Mexico and Chile with Spanish
and Amerindian ancestry and Cubans with Spanish and
African admixture. The Cuban group had significant lower
TEE compared with Mexican and Chilean elderly; however,
when TEE was adjusted for FFM, these differences were not
significant. Therefore, the differences of TEE of Cuban
elderly can be owing to the fact that Cubans had a lower
RMR and body weight than their Mexican and Chilean
counterparts. RMR when adjusted for FFM was the same for
the three country groups. Also, the lower TEE is associated
with lower values of physical activity as determined by its
indicators: PALs, AEE (Table 2) and TEE adjusted by RMR
(Table 3), which showed that the Chilean elderly had the
lowest physical activity. The Mexican and Cuban environments were more similar in rurality; people tended to walk
longer distances in more difficult dirty roads and depended
more on agricultural activities for their subsistence. The
Chilean community tended to have more modern facilities
and more access to local public transport. In general,
participants were less involved in agricultural and farming
activities.
ERs are traditionally expressed as PALs, and it is recognized
as a convenient approach to categorize energy needs, which
allow accounting for body mass differences among individual by considering RMR (Starling and Poehlman, 2000). In
the previous FAO/WHO/UNU (1985) Expert Consultation, a
PAL of 1.51 was considered as an adequate daily energy
intake to match daily energy expenditure, when an individual 450 years of age had a body composition and level of
physical activity consistent with long-term good health.
However, the actual FAO/WHO/UNU Expert Consultation
Report on Human Energy Requirements (2004) based upon
DLW and the measurement of BMR for elderly men (60–80
years of age) reports a PAL of 1.61–1.62 given a body weight
range of 67.8–70 kg (BMI: 18.5–25 kg/m2). The subjects in
our study were within this range of body weight and BMI
(Table 1) and the PAL was slightly higher (1.7070.16). Also,
PAL for men, but not for women, was slightly higher than
the average obtained (1.6370.25) by Elia et al. (2000) from
some DLW studies with elderly subjects from developed
countries. Also, it was slightly higher to that reported (1.61–
1.62) in the latest FAO/WHO/UNU Expert Consultation
Report on Human Energy Requirements (2004).
For women in the same range of age and the BMI of men,
for a body weight of 59 kg, the PAL is 1.69 for those 60–70
years and is 1.55 for those 70–80 years (FAO/WHO/UNU
Expert Consultation Report on Human Energy Requirements, 2004). In our study, women had a PAL of
1.6270.13, which, as in the case of men, is most likely
related to their physical activity pattern. In the case of
women, the PAL is similar to that reported by Elia et al.
(2000) and the latest FAO/WHO/UNU Expert Consultation
Report on Human Energy Requirements (2004).
The main activities identified in these rural areas for men
included cleaning the fields, hauling branches, gardening
European Journal of Clinical Nutrition
with heavy power tools, tilling a garden, watering lawn or
gardens, standing or walking. Many of them worked
regularly in activities such as farming, feeding small animals,
baling hay, cleaning barns, weeding, cultivating vegetables
and carrying light objects. Other activities such as tailoring,
electrical work and plumbing were also part of the physical
activity pattern in the three countries. In the case of women,
the majority practiced house tasks like dusting, sweeping
and moping floors, changing linen, disposing of trash,
washing dishes, cooking, ironing clothes and child care. A
few of the women helped in some of the agricultural
activities mentioned for men. The recreational activities
reported for men and women of Cuba, Chile and Mexico
were only playing cards and playing board games.
ERs for older adults and elderly should be calculated based
on PAL as suggested by the FAO/WHO/UNU Expert Consultation Report on Human Energy Requirements (2004).
Considering the PAL determined in this study, two equations
were developed. Table 4 shows predictive equations for RMR
and total daily energy expenditure-based body weight and
sex for these rural elderly individuals. R2 values and s.e.m.
are similar to other equations reported (Blanc et al., 2004)
and to those of Schofield (FAO/WHO/UNU Expert Consultation Report on Human Energy Requirements, 2004).
If ERs are calculated from the RMR and TEE predictive
equations in this study for an average woman with a body
weight of 57.5 kg, 153 cm, 69.9 years of age and a PAL of
1.62, the result is 7.99 MJ/day with both equations. If we
follow the recommendation of the FAO/WHO/UNU Expert
Consultation Report on Human Energy Requirements
(2004), which applies Schofield’s equations and calculates
daily ER for women aged 460 years, according to BMR factor
or PAL ¼ 1.62, at the same body weight as above, the value is
8.0 MJ/day.
Applying the same procedure for an elderly man with a
body weight of 65.9 kg, 164 cm, 70 years of age and a PAL of
1.70, the resulting ER is approximately 9.9 MJ/day for the
RMR equation and 9.88 MJ/day for the TEE equation. The
recommendation of the FAO/WHO/UNU Expert Consultation Report on Human Energy Requirements (2004) is
9.96 MJ/day.
In conclusion, the present study showed differences in TEE
and PAL owing to sex and country. The average PAL in the
case of men was higher than the PAL reported either with
factorial approach or with the DLW method in free-living
elderly from developed countries. Predictive equation based
on RMR and TEE gave similar results as those calculations
from the latest ERs report (FAO/WHO/UNU Expert Consultation Report on Human Energy Requirements, 2004). We
acknowledge the fact that our sample is limited (40 subjects)
and much more when divided into groups, considering that
the data in the above report came from 108 subjects of the
same BMI range. It is plausible that the diversity of lifestyles,
body composition and physical activity from this group may
contribute to the development of stronger and better
predictive equations for this age group that in turn will
PAL in Latin American elderly
H Alemán-Mateo et al
1265
allow making better estimation of ERs in this growing elderly
population.
Acknowledgements
This study was supported by CONACYT, Mexico (25728-M).
We thank the volunteers of this study and Inocencio Higuera
C, Juan P Camou, Erik Dı́az B, Ramón Figueroa, Soledad
Figueroa, Osmany Cienfuegos and José Ramón Porrata
Mauri. We are also indebted to Julian Esparza Romero, Maria
Esther Hernandez, Ingrid Rolon, Rocio Berlangas, Milagros
Marcia Velasquez, Jimmy Hernandez, Ana Cristina Gallegos
Aguilar, Alma E Robles-Sardin, Nayeli Macias Morales, Maria
de los Angeles Sanchez and Alejandrina Cabrera for their
technical assistance.
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