Energy Expenditure in Pregnant Women with Obesity Does Not Support Energy Intake Recommendations

Jasper Most, Porsha M Vallo, L Anne Gilmore, Marshall St Amant, Daniel S Hsia, Abby D Altazan, Robbie A Beyl, Eric Ravussin, Leanne M Redman, Jasper Most, Porsha M Vallo, L Anne Gilmore, Marshall St Amant, Daniel S Hsia, Abby D Altazan, Robbie A Beyl, Eric Ravussin, Leanne M Redman

Abstract

Objective: This study aimed to identify factors that may predispose women to excess gestational weight gain (GWG).

Methods: Seventy-two healthy women with obesity (30 class I, 24 class II, 18 class III) expecting a singleton pregnancy were studied at 13 to 16 weeks gestation. Energy expenditure (EE) was measured during sleep (SleepEE, average EE from 0200-0500 hours) in a whole-room calorimeter, and total daily EE (TDEE) over 7 days using doubly labeled water. Glucose, insulin, thyroid hormones, and catecholamines were measured.

Results: Body composition explained 70% variability in SleepEE, and SleepEE accounted for 67% to 73% of TDEE. Though there was no evidence of consistent low metabolism, there was considerable variability. Low SleepEE was associated with insulin resistance and low triiodothyronine concentrations (both P = 0.01). Physical activity level was 1.47 ± 0.02. For women with SleepEE within 100 kcal/d of their predicted EE, TDEE was significantly less than the estimate (2,530 ± 91 vs. 2,939 kcal/d; P < 0.001) provided from the most recent gestational energy requirement model.

Conclusions: Pregnant women with obesity are inactive, possibly predisposing them to excess GWG. Current energy requirement models overestimate activity and may promote excess GWG in women with obesity. Furthermore, the observed large interindividual variability in basal metabolism may be important to consider when assessing the risk for excess GWG.

Trial registration: ClinicalTrials.gov NCT01954342.

Conflict of interest statement

Disclosures: The authors declared no conflict of interest.

© 2018 The Obesity Society.

Figures

Figure 1
Figure 1
Correlations between fat-free mass, sleeping and total daily energy expenditure (A, C, E) and residuals for total daily energy expenditure (TDEE, B), sleeping EE (SleepEE, D), and activity-related EE (AREE, F), by obesity class. Each data point represents one participant. For residual SleepEE, -100 kcal/d and 100 kcal/d are used to identify low and high metabolism.
Figure 2
Figure 2
Correlations between residual SleepEE, thyroid hormone T3 and insulin resistance. Each data point represents one participant. Subjects classified as having low, average and high metabolic rates are presented as open, grey and black circles, respectively. Regression lines are significant (T3: R2=0.15, and HOMA-IR: R2=0.17, both p<0.001).

References

    1. Kim SY, Dietz PM, England L, Morrow B, Callaghan WM. Trends in pre-pregnancy obesity in nine states, 1993-2003. Obesity (Silver Spring) 2007;15:986–993.
    1. Gavard JA, Artal R. The association of gestational weight gain with birth weight in obese pregnant women by obesity class and diabetic status: a population-based historical cohort study. Matern Child Health J. 2014;18:1038–1047.
    1. Adamo KB, Ferraro ZM, Brett KE. Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? Int J Environ Res Public Health. 2012;9:1263–1307.
    1. International Weight Management in Pregnancy Collaborative G. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017;358:j3119.
    1. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015:CD007145.
    1. Dodd JM, Turnbull D, McPhee AJ, et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ. 2014;348:g1285.
    1. Poston L, Bell R, Croker H, et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 2015;3:767–777.
    1. Clifton RG, Evans M, Cahill AG, et al. Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity. Obesity (Silver Spring) 2016;24:305–313.
    1. Sutton EF, Cain LE, Vallo PM, Redman LM. Strategies for Successful Recruitment of Pregnant Patients Into Clinical Trials. Obstetrics and gynecology. 2017;129:554–559.
    1. Jensen D, Webb KA, Davies GA, O'Donnell DE. Mechanical ventilatory constraints during incremental cycle exercise in human pregnancy: implications for respiratory sensation. The Journal of physiology. 2008;586:4735–4750.
    1. Siri WE. Body composition from fluid spaces and density: analysis of methods. 1961 Nutrition. 1993;9:480–491. discussion 480, 492.
    1. Keys A, Brozek J. Body fat in adult man. Physiological reviews. 1953;33:245–325.
    1. van Raaij JM, Peek ME, Vermaat-Miedema SH, Schonk CM, Hautvast JG. New equations for estimating body fat mass in pregnancy from body density or total body water. Am J Clin Nutr. 1988;48:24–29.
    1. Schoeller DA, Ravussin E, Schutz Y, Acheson KJ, Baertschi P, Jequier E. Energy expenditure by doubly labeled water: validation in humans and proposed calculation. The American journal of physiology. 1986;250:R823–830.
    1. Martin CK, Heilbronn LK, de Jonge L, et al. Effect of calorie restriction on resting metabolic rate and spontaneous physical activity. Obesity (Silver Spring) 2007;15:2964–2973.
    1. Hewitt MJ, Going SB, Williams DP, Lohman TG. Hydration of the fat-free body mass in children and adults: implications for body composition assessment. The American journal of physiology. 1993;265:E88–95.
    1. Sagayama H, Yamada Y, Racine NM, Shriver TC, Schoeller DA. Dilution space ratio of 2H and 18O of doubly labeled water method in humans. Journal of applied physiology. 2016;120:1349–1354.
    1. Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. The Journal of physiology. 1949;109:1–9.
    1. Nguyen T, de Jonge L, Smith SR, Bray GA. Chamber for indirect calorimetry with accurate measurement and time discrimination of metabolic plateaus of over 20 min. Medical & biological engineering & computing. 2003;41:572–578.
    1. Thomas DM, Navarro-Barrientos JE, Rivera DE, et al. Dynamic energy-balance model predicting gestational weight gain. Am J Clin Nutr. 2012;95:115–122.
    1. Jequier E, Acheson K, Schutz Y. Assessment of energy expenditure and fuel utilization in man. Annual review of nutrition. 1987;7:187–208.
    1. Rosenbaum M, Leibel RL. Adaptive thermogenesis in humans. Int J Obes (Lond) 2010;34(Suppl 1):S47–55.
    1. 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;318:467–472.
    1. World Health Organization. Technical Report Series No 724. Geneva: 1985. Energy and protein requirements: Report of a joint FAO/WHO/UNU expert consultation.
    1. Redman LM, Heilbronn LK, Martin CK, et al. Metabolic and behavioral compensations in response to caloric restriction: implications for the maintenance of weight loss. PLoS One. 2009;4:e4377.
    1. Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology. 1984;150:535–540.
    1. U.S. Department of Health and Human Services, editor. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Office of Disease Prevention and Health Promotion; Washington (DC): 2008.
    1. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Determining Optimal Weight Gain. In: Rasmussen KM, Yaktine AL, editors. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (DC): 2009.
    1. Butte NF, Wong WW, Treuth MS, Ellis KJ, O'Brian Smith E. Energy requirements during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr. 2004;79:1078–1087.
    1. Forsum E, Kabir N, Sadurskis A, Westerterp K. Total energy expenditure of healthy Swedish women during pregnancy and lactation. Am J Clin Nutr. 1992;56:334–342.
    1. Goldberg GR, Prentice AM, Coward WA, et al. Longitudinal assessment of energy expenditure in pregnancy by the doubly labeled water method. Am J Clin Nutr. 1993;57:494–505.
    1. Kopp-Hoolihan LE, van Loan MD, Wong WW, King JC. Longitudinal assessment of energy balance in well-nourished, pregnant women. Am J Clin Nutr. 1999;69:697–704.
    1. Lof M, Forsum E. Activity pattern and energy expenditure due to physical activity before and during pregnancy in healthy Swedish women. Br J Nutr. 2006;95:296–302.
    1. Heini A, Schutz Y, Diaz E, Prentice AM, Whitehead RG, Jequier E. Free-living energy expenditure measured by two independent techniques in pregnant and nonpregnant Gambian women. The American journal of physiology. 1991;261:E9–17.
    1. Melzer K, Schutz Y, Boulvain M, Kayser B. Pregnancy-related changes in activity energy expenditure and resting metabolic rate in Switzerland. Eur J Clin Nutr. 2009;63:1185–1191.
    1. Singh J, Prentice AM, Diaz E, et al. Energy expenditure of Gambian women during peak agricultural activity measured by the doubly-labelled water method. Br J Nutr. 1989;62:315–329.
    1. Tataranni PA, Harper IT, Snitker S, et al. Body weight gain in free-living Pima Indians: effect of energy intake vs expenditure. Int J Obes Relat Metab Disord. 2003;27:1578–1583.
    1. Berggren EK, O'Tierney-Ginn P, Lewis S, Presley L, De-Mouzon SH, Catalano PM. Variations in resting energy expenditure: impact on gestational weight gain. Am J Obstet Gynecol. 2017;217:445 e441–445 e446.
    1. Meng Y, Groth SW, Stewart P, Smith JAAn. Exploration of the Determinants of Gestational Weight Gain in African American Women: Genetic Factors and Energy Expenditure. Biol Res Nurs. 2017:1099800417743326.
    1. Ravussin E, Gautier JF. Metabolic predictors of weight gain. Int J Obes Relat Metab Disord. 1999;23 Suppl 1:37–41.
    1. Currie S, Sinclair M, Murphy MH, Madden E, Dunwoody L, Liddle D. Reducing the decline in physical activity during pregnancy: a systematic review of behaviour change interventions. PLoS One. 2013;8:e66385.
    1. ACOG Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2015;126:e135–142.
    1. Gilmore LA, Butte NF, Ravussin E, Han H, Burton JH, Redman LM. Energy Intake and Energy Expenditure for Determining Excess Weight Gain in Pregnant Women. Obstet Gynecol. 2016;127:884–892.

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