Resting energy expenditure depends on energy intake during weight loss in people with obesity: a retrospective cohort study

Handa, Tomoko; Onoue, Takeshi; Kobayashi, Tomoko; Wada, Eri; Hayase, Ayaka; Kinoshita, Tamaki; Yamagami, Ayana; Yasuda, Yoshinori; Iwama, Shintaro; Kawaguchi, Yohei; Miyata, Takashi; Sugiyama, Mariko; Takagi, Hiroshi; Hagiwara, Daisuke; Suga, Hidetaka; Banno, Ryoichi; Goto, Motomitsu; Arima, Hiroshi

doi:10.20945/2359-3997000000532

Original Article • Arch. Endocrinol. Metab. 67 (2) • Mar-Apr 2023 • https://doi.org/10.20945/2359-3997000000532 linkcopy

Resting energy expenditure depends on energy intake during weight loss in people with obesity: a retrospective cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: Resting energy expenditure (REE) decreases if there is reduced energy intake and body weight (BW). The decrease in REE could make it difficult for patients with obesity to maintain decreased BW. This study aimed to investigate the correlation among changes in REE, energy intake, and BW during the weight loss process in patients with obesity.

Materials and methods: We conducted a retrospective cohort study of patients hospitalized for the treatment of obesity in Japan. Patients received fully controlled diet during hospitalization and performed exercises if able. REE was measured once a week using a hand-held indirect calorimetry. Energy intake was determined by actual dietary intake.

Results: Of 44 inpatients with obesity, 17 were included in the analysis. Their BW decreased significantly after 1 week (−4.7 ± 2.0 kg, P < 0.001) and 2 weeks (−5.7 ± 2.2 kg, P < 0.001). The change in REE after 1 and 2 weeks was positively correlated with the energy intake/energy expenditure ratio (r = 0.66, P = 0.004 at 1 week, r = 0.71, P = 0.002 at 2 weeks). Using a regression equation (y = 0.5257x – 43.579), if the energy intake/energy expenditure ratio within the second week was 82.9%, the REE after 2 weeks was similar to the baseline level. There was no significant correlation between the change in REE and BW.

Conclusions: Our data suggest that changes in REE depend on energy intake/energy expenditure ratio and that the decrease in REE can be minimized by matching energy intake to energy expenditure, even during the weight loss process.

Keywords
Resting energy expenditure; weight loss; energy intake

	Patients with REE data of 3 points (n = 17)
Age (years)	47.6 ± 12.4
Sex, male	12 (70.6%)
Body weight (kg)	115.0 ± 22.9
BMI (kg/m²)	42.4 ± 9.3
Waist circumference (cm)a	135.3 ± 9.8
Type 2 diabetes	12 (70.6%)
Hypertension	16 (94.1%)
Dyslipidemia	15 (88.2%)
Hyperuricemia	8 (47.1%)
Proteinuria	7 (41.2%)
Cardiovascular disease	3 (17.6%)
Cerebrovascular disease	1 (5.9%)
NAFLD	11 (64.7%)
OSAS, OHS	5 (29.4%)
Musculoskeletal diseasesb	4 (23.5%)
Thyroid disease	0 (0%)
Oral steroids	0 (0%)
Anti-obesity drugc	1 (5.9%)
Diuretic	9 (52.9%)
SGLT-2 inhibitor	2 (11.8%)

	(Baseline)	(1 week)	(2 weeks)
	the first measurement	the second measurement	the third measurement
Body weight (kg)	115.0 ± 22.9	110.3 ± 22.0**	109.3 ± 21.5**
BMI (kg/m²)	42.4 ± 9.3	40.7 ± 9.0**	40.3 ± 8.6**
Energy intake (kcal/day)	1623 ± 292	1566 ± 303	1558 ± 192
REEm (kcal/day)	1589 ± 454	1551 ± 378	1492 ± 343
REEp (kcal/day)	1947 ± 353	1893 ± 344**	1881 ± 339**
REEm-p (kcal/day)	−357 ± 314	−342 ± 271	−390 ± 221
EE (kcal/day)	2257 ± 740	2203 ± 647

	Average	SD	r	P-value
Energy intake/EE ratio in the first week (%)	79.7	29.7	0.66	0.004
Change in REEm after 1 week (%)	−0.2	15.3
Energy intake/EE ratio in the second week (%)	75.3	17.7	0.71	0.002
Change in REEm after 2 weeks (%)	−4.0	13.2
Energy intake/EE ratio in the first week (%)	79.7	29.7	0.58	0.015
Change in REEm-p after 1 week (kcal/day)	15.3	157.8
Energy intake/EE ratio in the second week (%)	75.3	17.7	0.64	0.005
Change in REEm-p after 2 weeks (kcal/day)	−32.1	175.5

	Average	SD	r	P-value
Change in body weight after 1 week (%)	−4.1	1.5	0.12	0.646
Change in REEm after 1 week (%)	−0.2	15.3
Change in body weight after 2 weeks (%)	−4.9	1.3	−0.13	0.621
Change in REEm after 2 weeks (%)	−4.0	13.2
Change in body weight after 1 week (%)	−4.1	1.5	0.06	0.831
Change in REEm−p after 1 week (kcal/day)	15.3	157.8
Change in body weight after 2 weeks (%)	−4.9	1.3	−0.27	0.287
Change in REEm−p after 2 weeks (kcal/day)	−32.1	175.5
Change in body weight after 1 week (%)	−4.1	1.5	−0.03	0.911
Energy intake/EE ratio in the first week (%)	79.7	29.7
Change in body weight after 2 weeks (%)	−4.9	1.3	0.005	0.986
Energy intake/EE ratio in the second week (%)	75.3	17.7

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[TFN1] Data were expressed as mean ± SD, or n (%) values. REE: resting energy expenditure; BMI: body mass index; NAFLD: nonalcoholic fatty liver disease; OSAS: obstructive sleep apnea syndrome; OHS: obesity hypoventilation syndrome; SD: standard deviation; SGLT-2 inhibitor: sodium-glucose co-transporter-2 inhibitor.

[TFN2] ^a
n = 6. Eleven patients had missing data about the waist circumference.

[TFN3] ^b
Two patents presented with gonarthrosis and another two with hip osteoarthritis.

[TFN4] ^c
One patient was treated with Bofutsushosan.