Análise crítica dos requerimentos energéticos em populações e gasto energético total diário por água duplamente marcada em adultos de Niterói, Rio de Janeiro

Abstract

Health intervention and maintenance policies aimed at the population are based on the energy requirement (ER) guided by the total daily energy expenditure (TDEE). Due to the difficulty in assess the TDEE, the Food and Agriculture Organization of the United Nations (FAO/WHO, 2004) and the National Academy of Sciences, Engineering and Medicine (NASEM, 2023) suggest the use of predictive equations to calculate the population TDEE. However, in clinic routine they are used to identify the individual ER in order to help the management of energy intake (EI) since it must correspond to the TDEE and their imbalance in the long run could jeopardize health. When the EI is greater than the TDEE, the development of overweight/obesity and chronic non-communicable diseases associated with these nutritional profiles is expected. Faced with the reality of the advance in the prevalence of overweight/obesity in the world population, understanding the problems found in the ER determination is important to understand the nutritional profile of population so that the planning of public health policies is more efficient. This thesis is based on two articles. In the first, the accuracy of EI reported by the Brazilian population or the inadequacy of the estimation of TDEE and ER based on data collected by the Family Budget Survey (2008-2009) was assessed. The energy balance (EB) was negative when using the ER estimated by the Dietary Recommended Intake (DRI) equations (IOM, 2005) (-1717 and -1215 kJ.day-1 in men and women, respectively). The ER calculated using the population-specific basal metabolic rate (BMR) equations and the physical activity level (PAL) of 1.4, presented EB close to zero in men (+18 kJ.day-1) and negative in women (-264 kJ.day-1) which is consistent with the nutritional profile of the Brazilian population. In the second, it was assessed the accuracy of estimating the BMR using predictive equations, the TDEE using data from 24h-physical activity recalls (PAR24h) and the ER proposed by FAO/WHO (2004) and by NASEM (2023). Double labeled water (ADM) was the reference method to assess the TDEE of adults (20–64 years) living in the city of Niterói, Rio de Janeiro, Brazil. The BMR equations suggested by Schofield (1985) were not accurate (difference of 16.5±8.4% of the measurement). However, when using the Anjos et al. (2014) equation for men was accurate (difference of -1.0±6.6% of the measurement). TDEE was only observed when using the population-specif equations for MET and BMR (difference of 4.1±17.9% of the DLW). ER was accurate when using BMR population-specif equations and the proxy of PAL in women (difference of -0.1±18.3% of DLW). NASEM equation proved to be inaccurate, regardless sex (difference of 12.0 ± 8.7% of DLW). This study is important by the fact that data were collected with gold standard methods for TDEE and BMR which could establish the PAL value. The PAR24h, a subjective, simple and inexpensive method, was able to estimate the TDEE and a proxy of PAL, but it is not suitable for estimating the individual ER due to the great variability in the TDEE data.