UNIT 2 HUMAN ENERGY REQUIREMENTS

Structure
2.1 Introduction
2.2 Energy: Some Basic Concepts
2.3 Definition and Components of Energy Requirement
2.4 Factors Affecting Energy Expenditure and Requirement
2.4.1 Factors Affecting the BMR
2.4.2 Factors Affecting tile T l i ~ r ~ l ~
Effect
i c of Food
2.4.3 Factors Affecting the Energy Expended in Pl~ysicalActivity
2.5 Methods of Estimation of Energy Expenditure and Requirements
2.5.1 Direct Calorin~elry
2.5.2 Indirect Calo~i~netry
2.5 3 Double ~ a b k l e dWater (DLW) Technique
2.5.4 Heart Rnte Monitoring (MRM) Method
2.5.5 Factoriill Estlmat~onof Total Energy Expenditure
2.6 . Energy Requirements and Diehry Energy Recommendations
2.6.1 Energy Recluiremcnts or Inhnts (from Birlh to I2 Months)
2.6.2 Energy Recluireinent k)r child re^^ and Adolescents
2.6.3 Energy Requirement of Adults
2.6.4 Energy Requirement cluring Pregnancy
2.6.5 Energy Requirement during Lactation
2.7 Energy Imbalance: An Overview
2.8 Let Us Suin Up
2.9 Glossary
2.10 Answers to Check Your Progress Exercises

2.1 INTRODUCTION
This unit focuses on the human energy requirements. The nutrient requirement for
Indian population, you may recall studying in the last unit, are coinpuled by the Indian
Council of Medical Research (ICMR) and published in its recent "Nutrient
Requirements and Recomnlended Dietary Allowance for 1ndians"(l989 repr&ted in
1998). The energy requirements have been computed on the basis of recommendatioils
made by a Joint Expert Consultation of the World Health Orgmization(WHO)/Food
and Agricultural Organization (FAO)/United Nations University (UNU) in 1985 and
by a11 Expert Conunittee constituted in 1988 by ICMR, These data, of course, have
to be continuously updated particularly now in the light of the new Food and Agriculture
Organization/World Health OrganizatiotlIUnitedNations University (FAOWHOIUNU)
recommendations.

A Joint FAO/WHO/UNU Expert Consultation on Human Energy Requirements,

convened in October 2001 at F A 0 headquarters in Rome, Italy has formulated
recokendations for human energy requirements published in 2004. The levels of
energy intake recommended by this expert consultation are based on estimates of the
requirements of healthy, well-nourished individuals. The recommendations that
have resulted from this consultation are important guidelines on energy in human
nutrition for the academia, scientists, nutritionists, physicians and other health workers,
as well as, for planners and policy-makers in both the agriculture and health sectors
throughout the world.
Advance .Nutrition The lCMR is in the process of now updating the earlier recommendations. Till such
time the new recommendations are published the old recommendations are being
followed in our countsy and have been included in this unit. The new FAO/WHO/
UNU 2004 recommendations for human energy requirements throughout the life
cycle are also presented in this unit on the basis of which our new recommendations
for energy may be formulated in course of time.

What are the components of energy requirement? Which are the factors which
influence the energy expenditure and requirements of individuals? What are the old
and new methods we can use for measuring the energy expenditure and requirement?
What are the problems associated with high and low energy intakes? These me some
of the issues covered in this unit.
Objectives
After studying this unit, you will be able to:
define the units of energy and physiological fuel value of foods,
discuss the components of energy requirements,
describe the methods of estimation of energy requirements,
0 define and explain the basis for formulating the energy requirements of different
physiological groups, and
critically 'analyze the regulation of energy metabolism- probleins associatecl with
high and low energy intake.

2.2 ENERGY: SOME BASIC CONCEPTS

Energy in simple terms inay be defined as the ability, or power, to do work. As a
student of dietetics and nutrition, you already know that h e pl~ysiologicalsources of
energy are carbohydrates, protein, fats - the nlacronutrients present in food. Energy
is released by the metabolism of food and the potential energy value of foods is
expressed in terms of the kilocalorie (Kcal). A kilocalorie is defined as the arnouizt
of heat required to raise the tenzperat~nreof 1 kg o f water through I' Celsius
(centigrade). Internationally, you may notice that the unit of energy measurement
commonly used is the Joule (J). It expresses the amount of energy expended when
1 kg of a substance is moved 1 meter by a force of 1 newton. The conversion factor
for changing kilocalories to 1ciIojoules is 1 kilocalorie = 4.184 kilojoules.
The amount of heat energy (kilocalorie) per grim1 that can be made available to the
body by each of the energy-yielding macronutsients - carbohydrate, protein, fat -
must be known to you. Yes, 1 g of carbohydrates yields 4 Kcal, 1 g of fat yields
9 Kcal, and 1 g protein yields 4 Kcal. These values are known as the physiological
fuel factors,
D o you know how the energy in various foods is generally measured? The amount
of energy available in a food is precisely determined by a laboratory technique known
as cnlorinzetry. In this process, a weighed amount of food is placed inside a metal
container called a bonzb culorimeter, which is immersed in water. The food is then
ignited in the presence of oxygen and burned. The incrcase in temperature of the
surrounding water is measured and used in calculating the number of kilocalories
given off by the oxidation of the food,

An alternate method of measuring food energy is to use the macronutrient composition

of foods in the food composition tables and by using tllc physiological file1 factors
referred to earlier. The Indian Council of Medical Research (ICMR), India has
published food value tables in a book titled 'Nutritive Value of Indian Foods'. Cei-tainly,
as a student of nutrition or dietetics, you may have r e f e ~ ~ elad this book some time
or other.
 With this basic understanding of the measurement of energy, let us move on to Huinan Energy
studying the energy requirements. But before we move on to the requirements we Requirements
must give a definition of what we understand by energy requirements and also know
about the components of energy requirements. These are described next.

r
2.3 DEFINITION AND COMPONENTS OF ENERGY
REQUIREMENT
We shall begin our study in this section by first understanding what we mean by
b
energy requirement. Energy requirement (EX) is defined as 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, and also to allow
optimal growth and development of children, deposition of tissues during pregnancy,
and secretion of milk during lactation, consistent with long-ten1 good health. For
healthy, well-nourished adults, it is equivalent to total energy expenditzlre (TEE).
There are additional energy needs to support growth in children and in wonlen during
pregnancy, and for milk production during lactation.
Total energy expenditure (TEE), may be delined as the energy spent, on uveruge,
in a 24-hour period by an individzlal or a group of individuals. By delinition,
it reflects the average amount of energy spent in a typical day, but it is not the exact
amount o l energy spent each and every day.
The energy needs vary widely among iildividuals in a group. You will find it iinpossible
to compute an individuals energy need without knowing something about the personal
lifestyle and metabolism. Consider the following situations:
Situation I : A 30 year old women who bikes, and swims each day, would require
more energy than a 30 year old who does a desk job.
Situation 2: In a group of' 20 odd people, with similar body weight and activity levels,
some individuals may require more energy per day than others.
Why do you think the energy requirements are different in these situations?
Well the requirement is dependent on the ways in which the body spends energy. For
example in the first case the intensity of work or voluntary activity i.e. intentional
activities (such as cycling, swimming) conducted by voluntary muscles affects the
amount of energy used, hence the variation in the requirement. On the other hand,
think of all the involuntary activities of our body that are necessary to sustain lire,
including circulation, respiration, temperature maintenance, hornlone secretion, nerve
activity, new tissue synthesis etc. All these involuntary activities of the body, which
continue day in and day out without our conscious awareness, require energy. Further,
as the food is chewed, digested, absorbed, these metabolic respoiise to food increases
total energy expenditure. Therefore, the human beings need energy for the following:
Basal metabolisnz. This comprises a series of functions that are essential for
life, such as cell function and replacement; the synthesis, secretion and metabolism
of enzymes and hormones to transport proteins and other substances and
molecules; the maintenance of body temperature; uninterrupted work of cardiac
and respiratory muscles; and brain function. The amount of energy used for
basal metabolism in a period of time is called the basal metabolic rate (BMR).
BMR is measured under standard conditions that include being awake in the
supine position after 10 to 12 hours of fasting and eight hours of physical rest,
and being in a state of mental relaxation in an ambient environmental temperature
that does not elicit heat-generating or heat-dissipating processes, Depending on '

age and lifestyle, BMR represents 45 to 70 percent of the total daily energy
Advance Nutrition expenditure, and it is determined mainly by the individual's age, gender, as well
as, body size and body composition. We will learn more about these factors
which influence the BMR in the next section.
BMR is con~monlyextrapolated to 24 h to be more meaningful, it is then refei~ed
to as Basal Energy Expertdit~~re (BEE) and is expressed as Kilocalories per
24 hours. The basal metabolic rate, as defined originally by Boothby and
Sandiford was measured in the morning upon awakening, before any physical
activity and 12-18 h after a meal. A closely related term used now is Resting
Metabolic Rate ( RMR). RMR is measured with the subject in a supine or
sitting position in a comfoi-table environment several hours after a meal and
without any significant activity. RMR is slightly higher than BMR but the
difference is small. RMR when extrapolated to 24 hours is the resting energy
expenditure (REE).
@ Metabolic response to food. Eating requires energy for the ingestion and
digestion of food, and for the absorplion, transport, interconversion, oxidation and
deposition of nutrients. These metabolic processes increase heal production and
oxygen consun~ption,and are known by terms such as 'dietary-ind~~ced
thermpgenesis', 'specific dynanzio action of food' and 'thermic eSfect of
, feeding' (TEF). The metabolic response to food increases total energy
expenditure by about 10 percent oftlze BMR over a 24-hour peliod in individuals
eating a mixed diet.
Physical activity. This is the most variable and, after BMR, the second largest
component of daily energy expenditure. Humans perform obligatory and
discretionary physical activities. Obligatory activities can seldom be avoided
within a given setting, and they are imposed on the individual by economic,
c~tlturalor societal demands. The term "occupational" was used earlier in the
WHO/FAO/UNU 1985 report but the preferred term now is obligatory as it
is more comprehensive. In addition to occupational work, obligatory activities
include daily activities such as going to school, attending to the home and family
and other demands made on children and adults by their economic, social and
cultural environment. Discretionary activities, although not socially or
economically essential, are important for health, well-being and a good quality
of life in general. They include the regular practice of physical activity for
fitness and health, the performance of optional household tasks that ]nay contribute
lo family comfort and well-being; and the engagemen1in individually and socially
desirable activities for personal enjoyment, social interaction and community
development. We will dwell further on this aspect later imi this unit; however, we
need to look at two concepls in the context of physical activily namely physical
activity level (PAL) and physical activity ratio (PAR), which find extensive use
in calculating the total energy requirement of healll~y,well-nourished adults.
Physical activity level (PAL) is defined as the total energy required over 24
hours divided by the energy needed for basal metabolis~n over 24 hours. In
simple terms, TEE for 24 hours expressed as a multiple of BMR, and calculated
as TEE/BMR for 24 hours. In adult men and non-pregnant, non-lactating women,
BMR multplied by PAL is equal to TEE or the daily energy requirement.
Physical activity ratio (PAR): The energy cost of an activity per unit of time
(usually a minute or an hour) expressed as a multiple of BMR.It is calculated
as energy spent in an activity/BMR, for the selected time unit.
Growth. The energy cost of growth has two components: I) the energy needed
to synthesize growing tissues; and 2) the energy deposited in these tissues. The
energy cost of growth is about 35 percenl of total energy requirement during the
first three months of age, falls rapidly to about 5 percent at 12 inontl~sand aboul
3 percent in the second year, remains at 1 to 2 percent until mid-adolescence,
and is negligible in the late teens.
 e Pregnancy. During pregnancy, extra energy is needed for the growth of the Human Energy
Require~ncnts
foetus, placenta and various matelnal tissues, such as in the uterus, breasts and
fat stores, as well as, for changes in mate~nalmetabolism and the increase in
maternal effort at rest and during physical activity.
m Lactalion. The energy cost of lactation has two components: I) the e n e r a
r content of the milk secreted, and 2) the energy required to producc that milk.
Well-nourished lactating women can derive part of this additional
from body fat stores accumulated during pregnancy.

: ' From our discussion above, it is evident that the total energy expenditure over a 24-
hour period is the sum of BMR, TEF, and energy for physical activities as also
highlightedrin Figure 2.1. For adults, this is equivalent to daily energy requirements.
Additional energy for deposition in growing tissues is needed to determine energy
requirenlents in infancy, childhood, adolescence and during pregnancy, and for the
production and secretion of milk during lactation. Energy balance is achieved when
input (i.e, dietary energy intalie) is equal to the output (i.e. total energy expenditu~~),
plus the energy cost of growth in childhood and pregnancy, or the energy cost to
~rcidycemilk during lactation. When energy balance is lnilintained over a prolonged
period, a11 individual is considered to be in a steady slate.

I Physical I
,. .
I hnmogencsis

BMR

".

Figwe 2.1: Componcnts of total energy ~xpexidilure

In the next section, we shall review the factors which influencer,theenergy expenditure
and requirements.
7

2.4 " FACTORS AFFECTING ENERGY EXPENDITURE

AND REQUIREMENT
\ I

As mentioned earlier, the energy needs v a y widely among individuals in a group.

Why? A number of factors cause the RMR or more approptiately the REE to vary
among individuals. Major determinants are the body size, comnposition, age, sex,
growth etc. Similarly, there are factors affecting the thermic effect of food and
energy expended in physical activity. A brief review on these factors follows.

2.4.1 Factors Affecting the BMR

Basal metabolic rate, we know, is the largest component of the daily energy demand
representing 45 to 70 percent of daily total energy expenditure. It is highly variable
and the causes of this variation include factors such as fat free mass (FFM), fat mass
Advance Nutrition (FM), age, sex, hormonal status, growth, diseaselinfections etc. Let us learn about
these factors starting with body size and composition.
Body size and composition: Basal and resting energy expenditures are related to
body size, being most closely correlated with the size of the fat:fiee Inass (FFM),
which is the weight o f the body less the weight of its fat muss. The size of the
FFM generally explains about 70 to 80 percent of the variance in RMR. FFM is the
metabolicaly active tissue in the body; what we also call as the lean body mass
(LBM) and so most of the variation in BMR between people can be accounted for
by the variation in their FFM. For example, athletes with greater muscular development
have approximately a 5% higher basal metabolism than non-athletic individuals. Thus,
exercise can help maintain a higher lean body mass and hence a higher metabolic
rate. Similarly, the lower basal metabolic energy requirement of women is primarily
related to their generally lower amount of lean muscle tnass (more of fat mass) as
compared to men. The decline in BMR with increasing age is also to some extent
the consequence of changes in the relative size of organs and tissues. Further larger
people (big size) have higher n~etabolicrates than people of smaller size. In fact,
individuals with greater surface area have higher metabolic rate. To illustrate, if two
people of different heights weigh the same, the taller individual with the larger body
surface area will have a higher inetabolic rate. In adults with higher percentages Bf
body fa1 composition, mechanical hindrances can also increase the energy expenditure
associated with certain types of activity.
Age: The B M R per unit weight also varies with age, being higher in cl~ildrenand
lower in the elderly. The loss of FFM with ageing is associated with a decline in the
metabolic rate, amounting to about 1-2% decline per decade after early adulthood
The REE is highest during the periods of rapid growth, chiefly during the first and
second year of life, and reaches a lesser peak through the periods of puberty and
adolescence in both sexes.

Gender: We have already emphasized earlier that sex difference in metabolic rates
are priinarily attributable to difference in body size and composition. Women who
have generally more fat in propo tion to muscle than men, have metabolic rates which
are 5-10% lower than men of the same weight and height. Thus, differences in BMR
between genders are due to the greater level of body fatness in women.

Hormonal Status: Thyroid status may be most important factor and can make
differences of up to plus or minus 50% for hyperthyroidism or hypothyroidism,
respectively. Hyperthyroidism increases the resting metabolic rate, whereas
hypothyroidism decreases the RMR. Stimulation of the sympathetic nervous system
(e.g. during the period of stress or emotional excitenlent or fear, anxiety) causes the
release of epinephrine, which directly promotes glycogenolysis and inclseasescellulas
activity. This too is associated with increased metabolic rate. 111adull prenlenopausnl
women, the metabolic rate fluctuates with the menstrual cycle. An average of
359 Kcall day difference in the BMR has beet] measured between the low point,
about 1 week before ovulation on day 14, and the high point, just before the onset
of nlenstruation.

Enviroizmental Conditiorz.~:Extremes in environmental temperi~turesalso affect the

metabolic rate. Energy expenditure will be increased if extra heat p~-oductionis
needed to maintain body temperature in a cold climate. The extent to which the
energy metabolism increases in extremely cold environment depends on the itlsulation
available from .body fat and protective clothing. Conversely, there is some evidence
that the basal metabolic rate is reduced in hot clin~ates.For example, BMK is on an
average 10% lower in Iildiails than in North Europeans. Further exercise undertaken
in temperatures greater than 86" also imposes an additional ~lletabolicload of about
5% from increased sweat gland activity.

r
 Besides climatic conditions, altitude too has been shown to affect metabolic rates. Human Energy
Hypoxia (lack of oxygen in tissues) of high altitude increases BMR. Hypoxia increases Requirements
glucose utilization, wlich might affect the lnetabolic rate. However, these are temporay
effects, which disappear with acclimatization. We learn more about this aspect later
in Unit 18 at the end of this course.
Pregnancy and Lactation: These periods of physiological stress also have an impact
on the metabolic rate. Earlier, we studied that REE is highest during the periods of
rapid growth, i.e. c,hiefly during the first and second year of life, In pregnancy too,
which is the foetal growth period, the nletabolic rate increases, particularly later in
pl.egnancy because of uterine, placental and foetal growth and the mother's increased
cardiac work load.
Fever/Illne,ss/I~fectiorzs/Injury:Any illness or fever caused by an illness influences
the metabolic rate. Fevers increase the lnetabolic rate by about 7% for each degree
increase in body temperature above 98.G°F or in other words 13% for each degrec
above 37°C.
During injury or infections there is an increased BMR, and this increase is dependent
on the severity of the injury. For example, the BMR may even double with bums of
more than 40% of the body sui-face, in severe sepsis, multiple traumas, whereas it
may only increase by about 25% in patients with long bone fractures and even less
after surgery. But we need to understand that in sick patients who are likely to be
in bed, the increase in the BMR due to the stress imposecl by the disease may be
offset by the decrease in physical activity, such Lhat the total daily energy expenditure
may not change drastically.
Nutritional status: Undernutrition and starvation are the factors which require
consideration. Prolonged undernutrition or starvatioil causes a reduction of about
10-20% in BMR. In semi-st:uvation studies, data suggest Lhnt the subjects BMR
decrease by about 25% when expressed per kilogram of their frce fat Inass (FFM)
(or metabolic active tissue). Reduction in BMR are partly mediated through weight
loss itself, in which l~letabolicallydemanding tissue of the body (the IjFM i.e. the lean
body tissue) are reduced in size, and pallly through reduction in the metabolic activity
of these tissues. We will leam more about this aspect later in section 2.6 in this unit.
Other Factors: Smoking is one variable thought to influence the lnetabolic rate.
Smoking increases BMR, cessation of smoking lowers BMR. The BMR in sleep is
about 5% less than in the basal condition.
Thus, there is an,exhaustive list of factors which influence BMR and hence the total
energy requirements, under different coizditions. Next, we shall move on to the study
of the factors affecting the tlieimic effect of food.

2.4.2 Factors Affecting the Thermic Effect of Food

The thermic effect of food, as we learnt earlier, is the increase in energy expe~lditure
associated with the consumption of food and it accounts for approximately 10% of
TEE (Total ' ~ n e Expenditure).
r ~ ~ The intensity and duration of meal induced TEF
(Thermic effect of food) is, however, determinecl primarily by the amount and
composition of the foods consumed. TEF, for excunple, is greater aJer. consurnl;rtio~z
of carbohydrate and protein than ufter fat. The increments in energy expenditure
during digestion above baseline rates, divided by the energy content of the food
consumed, vary from 5 to 10 percent for carbohydrate, 0 to 5 percent for fat, and
20 to 30 percent f& protein. The high TEF for protein reflects the relatively high
metabolic cost involved in processing the amino acids yielded by absorption of dietary
protein, for protein synthesis, or for the synthesis of urea and glucose. Activation of
the sympathetic nervous system elicited by dietary carbohydrate and by sensory
stimulation causes an increase in energy expenditure.
Advance Nutrition Consumption of the usual mixture of nutrients (i.e. a mixed diet) is generally considered
to elicit increases in energy expenditure equivalent to 10 percent of the food's energy
content. Spicy foods enhance and prolong the effect of TEE Meals with chili and
mustard may increase the metabolic rate as much as 33% more than unspiced meal,
and this affect may last for more than 3 hours. Caffeine and nicotine also stimulate
TEF.
Next, we shall review the factors influencing the energy expended on physical activity.

2.4.3 Factors Affecting the Energy Expended in Physical Activity

Physical activity as we learnt earlier, is the second largest component of daily energy
expenditure, after BMR. However, the energy expended in physical activity is most
variable as it may range from 10% in a person who is bedridden to as much as 50%
of TEE in an athelete. In fact, different lfestyles have different levels of energy
demands. The examples of lifestyles with different levels of energy demands as given
by FAO/WHO/UNU 2004 are enumerated herewith.
@ Sedentary or light activity lifestyles: These people have occupations that do
not demand much physical effort, we not required to walk long distances,
generally use motor vehicles for transportation, do not exercise or participate i n
sports regularly, and spend most of their leisure time sitting or standing, with little
body displacement (e.g. talking, reading, watching television, listening to the
radio, using computers). One example is malelfemale teachers, ofrice workers
(executives, clerks, typists etc.) in urban areas, who only occasionally engage
in physically demanding activities during or outside working hours. Another
exillnple are housewives living in urban areas with access to energy saving
devices and domestic help to carry out most of the manual chores and other
moderate energy activities.
Active or moderately active lfestyles: These people have occupations that p-e
not strenuous in terms of energy demands, but involve Inore energy expenditure
than that described for sedentary lifestyles. Alternatively, they can be pmple
with sedentary occupations who regularly spend a certain amount of .time in
moderate to vigorous physical activities, during either the obligatory or the
discretionxy part of their daily routine. For example, the daily peifol-mance of
one hour (either continuous or in several bouts during the day) of moderate to ,
vigorous exercise, such as jogging/running, cycling, aerobic dancing or various
sports activities. Other examples of moderately active lifestyles are associated
with occupations such as servants, house cleaners, masons and construction
workers, or rural women in less developed traditional villages who participate in ,
agricultural chores or walk long distances to fetch water and fuel wood.
0 Vigorous or vigorously active lfistyles: These people engage regularly in
strenuous work or in strenuous leisure activities for several hours. Exa~nplesare
women with non-sedentary occupations who swim or dance an average of two
hours each day, or non-mechanized agricultural labourers who work with a
machete, hoe or axe for several hours daily and walk long distailces over rugged
tei~ains,often carrying heavy loads. Other examples of vigorously active
occupations include rickshaw pullers, mine workers, coolies etc.
1
-....
I
Now that we have classified the different lifestyles, it is irnportallt to note that the
energy expended will vary not only with the different types of activity undertnken :;:
an individual (both occupational and discretionary phyjicnl activity), kilt nl,ro by
time spent in each activity/task and tlze ene,;Sy cost oJ' (%rich uctivity ilzroz~g'!~~! t
a theoretical 24-hour period. The classification OF lifestyles in relation to the e ' s c b y
cost of each activity or the intensity of habitual pl~ysicalactivity, oi. physical i:cSl'vity
level (PAL) is given in Table 2.1. Plzysical nctivit~~ lcvcl (l)AL), we leamr c;r lier, is
defined as the total energy required over 24 hours tlivirled by h e basal 111.rill olic rate
over 24 hours. In adult Inen and non-pregnaiit, non-lactating women, t31f 1R times
PAL is equal to TEE or the daily energy requisemcnt.
 Table 2.1: Classification of lifestyles in relation to the intensity of habitual physical activity, Human Energy
or PAL Requirements

Category PAL value

Seden~aryor light activity lifestyle 1.40 - 1.69
Active or moderately active lifestyle 1.70 - 1.99
Vigorous or vigorously active lifestyle 2.00 - 2.40";

'I: PAL values > 2.40 are dilficult to rrhintain over a long peiiod of time.
You would realize that the energy expended in physical activity tcnds to decrease
with age, a trend that as you may already be aware is associated wit11 a decljne in
FFM and an increase in fat mass which influences h e encrgy requiremeilt.

In addition to the iinnlediate energy cost of individual activities, physical activity also
affects energy expenditure in the post-esercise period. Excess post-exercise oxygen
consumptioi1 (EPOC) depends on exercise intensity and duration, as well as, other
factors, such as environmental temperatures, state of hydralion, and degree of trauma,
demonstrable sometimes up to 24 hours after exercise. Thc increase in daily energy
expenditure is somewhat greater, however, because exercise induces an additional
small increase in expenditure for some time after the exertion ilself has been completed.
This excess post-exercise oxygen consulnplioil (EPOC), as mentioned above, depends
on exercise intensity and duration and has been estimated at some 15 percent of the
increment in expenditure that occurs during exertions like walkingljogging.
,
There may also be chronic changes in energy expenditure associated with regular
physical activity as a result of changes in body co~npositionand a'lterations in the
metabolic rate of muscle tissue, neuroendocrine status, and changes in spontaneous
physical activity associated with altered levels of fitness. Habitual exercise does not
cause a significant prolonged increase in metabolic sate per unit of active tissue, but
it does cause an 8-14% higher nletabolic rate in mcn who are xnoderately and highly
active because of their increased fat free mass i.e, lean body tissue. Since FFM is
the major predictor of BMR and RMR, increases in lTM due to increased physical
activity would be expected to increase BMR or RMR. The level of fitness also
affects h e energy expenditure of voluntary activity, probably because of va~iationin
muscle mass.

To conclude, intensity, duration and jreq~ietzcjl cf tlze activity, the body mass of
the person, qfficiency at perfornzilig the activity and age influences the energy
expended in physical activity.

Next, we shall move to a review the methoddlneans to calculate the energy expenditure
andlor requirements. But before let us recapitulate what we have learnt so far
by answering the cluestions in the check your progress exercise 1.

Check Your Progress Exercise 1

1) Define the following
Energy:. ............................................
Kilocalorie:. .....................................................................

Physiological fuel factor: ....................

,.. .
...........................,.:.,.
TEF: ...i . . , . ..............................................................................
.,

..........................................
4;.,...........;,,.........,..,.........,.............................,,.,

,. .
Advance Nutrition
2) List the different components of energy requirements.

......................................................................................................................
.....................................................................................................................
3) Define BMR? Give the factors which influence BMR.
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
4) Give the different lifestyle classifications with their PAL value.
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
Now let us learn about the methods we can use to measure energy expenditure and
requirements,

2.5 METHODS OF ESTIMATION OF ENERGY

EXPENDITURE AND REQUIREMENTS
There are a variety of methods available to measure human energy expenditure.
Knowledge of these methods will help us in calculating the expenditure either in the
practical sessions or in the research setting. some of these inethods covered in this
section include:
- Direct calorimetry
- Indirect calorimetry
- Factorial estimation
- The doubly labelled water (DLW) technique
- Heart rate monitoring (HRM)
Let us get to know about these techniques.

2.5.1 Direct Calorimetry

Calorimetry refers to the measurement of the ainount of heat evolved or absorbed
in a chemical reaction, change of state, or formation of a solution. Direct cnloriinetiy
is the method, which monitors the amount of heat produced by a subject placed inside
a structure large enough to pennit inoderate ainount of activity, These structures are
referred to as whole room calorimeters. This method provides a measure of energy
 expended in forin of heat, but provides no information on the kind of fuel being Human Energy
oxidized. Further, this method is limited by the high cost and by the confined nature Requirements
of the testing conditions i.e. the physical activity within the chamber is limited and
therefore not representative of free-living environment.

Another method to be considered is the use of a respiration chamber or of a direct

calorimeter. To obtain reliable data with either of these techniques involves an
experimental set-up which is both expensive and technically complex. Relatively few
of these chambers exist and their usefulness in the present context is restricted to
specific basic problems which do not require a natural free-living environment

2.5.2 Indirect Calorimetry

This method estimates energy expenditure by determining the oxygen co~lsumption
and carbon dioxide production of the body or a cell over a given period of time. Data
so obtained from this method permits calculation of the respiratory quolient (RQ)
which is expressed as:

moles CO, expired

RQ =
moles 0, consumed

The RQ indicates the source of metabolic energy. It ranges from 1.0 (carbohydrate
oxidation) to 0.7 (fat oxidation). On a inixed diet the RQ is about 0.85.

This determination is converted into kilocalories of heat produced per square meter
i of body surface area per hour and is extrapolated to energy expenditure in 24 hours.

2.5.3 Double Labeled Water (DLW) Technique

DLW is currently considered the most accurate technique for measuring TEE in free-
I living individuals. It is the method used to measure the average total energy expenditure
of free-living individuals over several days (usually 10 to 14), based on the
I
disappearance of a dose of water enriched with the stable isotopes 2Hand IXO.The
use of the doubly labeled water (DLW) (2H,'RO)technique to calculate total production
I
of carbon dioxide (CO,) over several day's and, from this, total energy expenditure
was originally developed for use in sinall maininals and its application was later
validated in humans. TEE measured by this method includes basal metabolism, the
metabolic response to food, thermoregulatory needs, physical activity costs, and the
energy cost to synthesize growing tissues. Consequently, energy requirements are
calculated as the sum of TEE plus the energy deposited as protein and fat in growing
tissues and organs.

2.5.4 Heart Rate Monitoring (HRM) Method

HRM is a method to measure the daily energy expenditure of free-living individuals,
based on the relationship of heart rate and oxygen consumption and on minute-by-
minute monitoring of heart rate.

Extrapolating from heart rate to energy expenditure is a method which has been
widely believed to be valuable and reasonably valid. The technique is fairly practicable,
there are several instruments on the market which are not very expensive, and it is
probably the method of choice in some population groups, such as young children, old
people, and ill people. This is not the place to give a detailed critique of the methodology,
other than to say that it must be used with circunlspection and an awareness of the
variable relationships of heart rate and energy expenditure.

Finally, let us learn about the factorial estimation of total energy expenditure which
is most practical and provides a good indication of total requirements.
Advance Nutrition 2.5.5 Factorial Estimation of Total Energy Expenditure
The wide variations observed in the physical activity patterns of adults from different
geographic, social and economic groups combined with the variations observed in
body size and composition of adults, do not allow the universal application of TEE
measured by DLW technique, described above, to be used directly for estimating
the energy requirements for adults. Therefore, the factorial estimate is used which
combines the time allocated to different habitual activities and the energy cost of
these activities expressed in multiples of BMR per unit of time, i.e. either per minute
or per hour. Total energy expenditure can, therefore, be estimated by a factorial
approach involving summation of all the expected components of energy expenditure,
including BMR and taking into account the energy costs of different activities and
their durations. Table 2.2 shows examples of these calculations. To account lor
differences in body size and composition, the energy cost of activities is calculated
as a multiple of BMR per minute also referred to as the physical activity ratio (PAR)
(refer to Table 2.2), and the 24-hour energy requirements are expressed as a multiple
of BNIR per 24 hours by using the PAL value. Together with BMR of the population,
PAL when known or when derived using BMR estimated from age and gender-
specific predictive equations based on the average body weight of the population
provides an estimate of TEE and hence the mean energy requirement For that
population.

It must be noted here thal the factorial approach should be used only for adults. It
should not be used in the case of infants and children.
Table 2.2: Factorial calculations of total energy expenditure f o r a population group

Time Energy Time x Mean PAL"

Main Daily Activities Allocation Costn Energy Multiple of
Hours PAR Cost 24-hour BMR

Sedentary or light activity lifestyle

Sleeping 8 1 8.0
Personal care (dressing, showering) I 2.3 2.3
Eating 1 1.5 1.5
Cooking 1 2.1 2.1
Silting (office work, selling produce, 8 1.5 12.0
tending shop)
General household work 1 2.8 2.8
Driving car to/f~,ornwork 1 2.0 2.0
Walking at varying paces without a load 1 3.2 3.2
Light leisure activities 2 1.4 2.8
(watching TV, chatting)
Total 24 36.7 36.7124 = 1.53
Active or rnoderalely active lifestyle
Sleeping 8 1 8.0
Personal care (dressing, showering) 1 2.3 2.3
Eating 1 1.5 1.5
Standing, carrying light loads
(waiting on tables, arranging merchandise)' 8 2.2 17.6
Commuting tolfrom work on the bus 1 1.2 1.2
Walking a1 varying paces witl~oula loild 1 3.2 3.2
LOW intensity aerobic exercise 1 4.2 4.2
Light lcisure activities 3 1.4 4.2
(watching TV, chatting)
Total 24 42.2 42.2124 = 1.76
 Human Energy
Vigorous or vigorously active lifestyle
Requirements
Sleeping 8 1 8.0
Personal care (dressing, bathing) 1 2.3 2.3
Eating 1 1.4 1.4
Cooking 1 2.1 2.1
Non-mechanized agricultural work 6 4.1 24.6
(planting, weeding, gatheling)
Collecting waterlwood 1 4.4 4.4
Non-mechanized domestic chores 1 2.3 2.3
(sweeping, washing clothes
and dishes by band)
Walking at varying paces without a load 1 3.2 3.2
Miscellaneous light leisure activities 4 1.4 5.6

Total 24 53.9 53.9124 = 2.25

"Energy costs of activities, expressed as multiples of basal metabolic rate, or PAR, are based
on data presented in Annexure I given at the end of the course.
"AL= physical activity level, or energy requirement expressed as a multiple of 24-Ilour BMR,
composite or the energy cost of standing, walking slowly and serving meals or cal~ying
a light load.
Let us understand this calculation with the help of an example. However, we shall
first learn about the use of predictive cquations to measure BMR.
We already know that BMR constitutes about 45 to 70 percent of TEE in adults, and
.- is determined principally by gender, body size, body ca~n~ositinn and age. It can be
measured accurately with sslnall intra-individual variation by direct or indirect calorimetry
under standard conditions as described above.+But, BMR can be measured only
under laboratory conditions and in small groups of representative individuals by these
methods. There is a need to estimate BMR at the population level when using the
factorial approach to estimate TEE from the average BMR and PAL value attributable
to that population. I-Ience, the alternative has been to estinlate a group's mean BMR
using predictive equations based on measurements that are easier to obtain, such as
body weight andlor height. The report from the 1985 FAO/WHO/UNU expert
consultation used a set of equations p~*oposeclin 1985 by Schojield derived mostly
fro111 studies in Western Europe and North America. Table 2.3 present these equations.
Table 2.3: Equations for estimating BMR from body weight*
Age No. BMR: MJ/dny see BMR: KcaVday see
Years
F
Males
<3 162 -
0.249 kg 0.127 0.292 59.512 kg - 30.4 70
3 - 10 338 0.095 kg + 2.110 0.280 22.706 kg + 504.3 67
-
10 18 734 0.074 kg + 2.754 0.441 17.686 kg + 658.2 105
18 -30 2879 0.063 kg + 2.896 0.641 15.057 kg + 692.2 153
-
30 60 646 0.048 kg + 3,653 0.700 11.472 kg + 873.1 167
> GO 50 0,049 kg + 2.459 0.686 11.711 kg + 587.7 164
Females
<3 137 0.244kg - 0,130 0.246 58.317 kg - 31.1 59
3 - 10 413 0.085 kg + 2.033 0.292 20.315 kg + 485.9 70
10 - 18 575 0.056 kg + 2.898 0.466 13.384 kg + 692.6 111
18 - 30 829 0.062,kg + 2.036 0.497 14.818 kg + 486.6 119
30 - 60 372 0.034kg + 3.538 0.465 8.126 kg + 845.6 111
> 60 38 0.038 kg + 2.755 0.451 9,082 kg + 658.5 108
* Weight is expressed in kg. Predictive equations for children and adolescents are
presented for the sake 01completeness.
see = standard error oT estimate.
Source: Schofield, 1985.
Advance Nutrition We can use these equations to estimate BMR from body weight. Multiplying the PAL
by the BMR then gives the actual energy requirements. The PAL values as given
in Table 2.1 for different lifestyles may be considered.

Now, let us understand the factorial calculation of total energy expenditure using the
predictive equations to estimate BMR and using the PAL values with the help of an
example.

Example: Manju is a female, 25 years of age, with a moderately active lifestyle and
a mean body weight of 55 kg. Now let us calculate her energy requirements.

Calculations:
0 From the Table 2.3, BMR calczllated from the predictive equation is: 5.45
MJIday (1302 Kcal/day) (i.e. 0.062 x 55 + 2.036 = 5.446 MJI 14.818 x 55 +
486.6 = 1301.59).
PAL from mid-point of the moderately active lifestyle in Table 2.1 is 1.85.
TEE o r Energy requirenzent: 5.45 x 1.85 = 10.08 MJ/day (2409 Kcal/du.yj, or
10.08155 = 1 83 kJ/kg/day (44 Kcal/kg/day).
We hope that with this excmlple you have understood the factorial estimation of total
energy requirement. In this mannel; with the help of the BMR predicitve equation and
the PAL value you can calculate the total energy expenditure (TEE) which will be
the energy requirement for the individual.

Few other examples specific to different lifestyles are presented next, to help you
understand the concept better,

Examples:
Sedentary o r light activity: If this PAL was from a female population, 30 to 50
years old, with mean weight of 55 kg and mean BMR of 5.40 MJIday (1290 Kcal/
day), TEE = 1.53 x 5.40 = 8.26 MJ (1975 Kcal), or 150 kJ (36 Kcal )/kg/d.

Active or moderately a c h e : If this PAL was from a feniale population, 20 to 25

years old, with mean weight 0157 kg and mean BMR of 5.60 MJ/clay (1338 Kctrl/
day), TEE = 1.76 x 5.60 = 9.86 MJ (2355 Kcal ), or 173 kJ (41 Kr.rtljlkgld.

Vigoro~fso r vigorou~lyactive: If this PAL was from a male population, 20 to 25

years old, with mean weight of 70 kg and mean BNIR of 7.30 MJIday (1745 Kr.~il/
day), TEE = 2.25 x 7.30 = 16.42 MJ (3925 Kcul), or 235 kJ (56 Kcnl )lkgld.

Next, let us study about the energy requirements for different age groups.

2.6 ENERGY REQUIREMENTS AND DIETARY ENERGY

RECOMMENDATIONS
Energy requirement, as you may recall studying earlier, is the anount of food energy
needed to balance energy expenditure in order to maintain body size, body con~position
and a level of necessary and desirable physical activity consistent with long-tenn
good health. This includes the cnergy needed [or the optimal growth and dcvclopment
of children, for the deposition of tissues during pregnancy, and for the secsetion of
milk during lactation consistent with the good health of mother and child. T l ~ e
recommended level of dietary energy intulke for a population group is the mean
energy requirement of the healthy, well-nourished individuals who constitute that
group.
 Energy requirements and recommended levels of intake are often referred to as Human Energy
daily requirements or I-ecommended daily intakes. These terms are used as. a Requirements
matter of convention and convenience, indicating that the requirement represents an
average of energy needs over a certain number of days, and that the recommended
energy intake is the amount of energy that should be ingested as a daily average
over a certain period of time.There is no implication that this amount of energy must
be consumed every day. or that the requirement and the recommended intake remain
constant day after day. A convenieilt time frame of one week has been often used
in practice for defining the number of days over which the requirement and the
recommended energy intake may be averaged, although there is no biological basis
for this or any other time frame. Considering that habitual physical activities may vary
on some days of the week a seven day period appears reasonable for averaging the
requirement and the recommended intakes.
Remember, estimates of energy requirements are derived froin measurements of
individuals. Measurements of a collection of individuals of the same gender and
similar age, body size and physical activity are grouped together to give the average
energy requirement - or recommended level of dietary intake - for a class of people
or a population group.
The energy needs for Indian population has been conlputed on the basis of
recoimnendations made by a Joint Expert Consultation of the World Health Organization
(WHO)/Food and Agricultural Organization (FA0)Nnited Nations University (UNU)
in 1985 and by an Expert Committee constituted in 1988 by the Indian Council of
Medical Research (ICMR) as already informed earlier in the introduction section.
However, recently the Joint FAO/WHO/UNU Expert Consultation on Human Energy
Requirements, convened in October 2001 at FA0 l~eadquarlersin Rome, Italy has
formulated recommendations for human energy requirements p~~blished in 2004. The
ICNIR is in the process of now updating the earlier recommendations. Till such time
the new recommendations are published the old recommendations are being followed
in our country. A brief review on these recommendations along with the new FA01
WHOJUNU 2004 recommendations for human energy requirements through out the
life cycle is presented herewith.

2.6.1 Energy Requirements of Infants (from Birth to 12 Months)

Energy requirements during infancy are very high because this is one of the periods
of very rapid growth. Energy requirement for infants and children of all age group
are based on the principle of calculating energy requirements from total energy
expenditure (TEE) plus the energy needs for growth. Energy needs for growth have
two components: 1) the energy used to synthesize growing tissues, which is part of
the total energy expenditure, and 2) the energy deposited in those tissues, basically
as fat and protein, because carbohydrate content is insignificant. This has to be taken
into account along with the basal energy needs and energy needs for activity in
infants and children.
Available data suggest that energy needs are highest during the first three months and
then fall over the next six months when the growth rates are lower. It rises again
after nine months as the child becomes physically more active. The RDA for infants
drawn by ICMR, as given in Table 2.4 takes this phenomenon inta account. The
requirements are categorized into two groups: 0-6 months and 6-12 months, and are
calculated as energy units per kilogram of body weight.
Tsble 2.4: RDA for infants and children
v
Energy per kg Net Energy . Body Weight (kg)
Body Weight (Kdd)
< 6 months
-
6 12 months 98kg 844 8.6 a

Source: ICMR, 1988.

Advance Nutrition Breastmilk is the best food for infants, and exclusive breastfeeding is strongly
recommended during the first six months of life which is sufficient to meet the energy
requirements. Thereafter, a combination of breastmilk and complementary foods
throughout infancy is recommended to meet the requirements. We will learn more
about the requirements and how to meet these requirements later in Unit 14.

Table 2.5 presents the FAOIWHOIUNU 2004 recommended average energy

requirements of infants from one to 12 months of age, combining the needs of
breastfed and formula-fed infants. TEE is calculated with the predictive linear equations
described later in this section. The sum of TEE and energy deposition is the mean
daily energy requirement (in MJ or Kcal). It is calculated as energy units per kilogram
of body weight, dividing the daily requirement by the median weight at each month
of age.

The TEE is lower among breastfed than formula-fed infants during the first year of
life; hence the energy requirements of breastfed infants are also lower, as you may
have noticed in Table 2.5.

Table 2.5: Energy requirement of breastfed, formula-fed and all infants

Age Breast-fed Formula-fed All bremst&formula-fed

Months Boys Girls Mean Boys Girls Mean Boys Girls Mean
 Compared with the values in the FAO/WHO/UNU 1985 report, energy requirements Human Energy
proposed by FAOIWHOPLTNU 2004 consultation are about 12 percent lower in the Requirements
first three months of life, 17 percent lower from three to nine months, and 20 percent
lower from nine to 12 months. The requirements for breastfed infants are 17, 20 and
22 percent lower than the 1985 estimates at ages 0 to three, three to nine and nine
to 12 months, respectively.

The equations to predict TEE from body weight of infants are as follows:
Breast-fed: Breast and formula-fed:
TEE (MJIday) = - 0.635 + 0.388 kg TEE (MJtkglday) = - 0.416 + 0.371 kg
TEE (Kcallday) = - 152.0 + 92.8 kg
Formula-fed:
TEE (MJIday) = - 0.122 + 0.346 kg
TEE (Kcallday) = - 29.0 + 82.6 kg
In populations around the worl.d, and particularly in India, we have large numbers of
newborns with intrauterine growth retardation, and malnourished children less than
one year of age. In addition to proper health, social and emotional support, these
infants require special nutritional care for a rapid, catch-up growth that will allow
thein to attain the expected weight and height of normal children born with adequate
size at term, and who have never been malnourished. Therefore, diets for catcli-up
growth must provide all nutrients and energy sourcesin amounts that are proportionally
higher than those required by well-nourished infants of adequate size. However it is
difficult to generalize the quantitative energy requirements for catch up growth and
it is best done on individual basis. Some tentative estimates as proposed by the FA01
I
WHO/UNU expert Consultation of 2001 are given in Table 2.6.

Table 2.6: Increase in energy requirements needed to allow for twice the normal growth rate
of children six to 24 months old*

Age (Months) Average Weight Gain % Increase Over Energy Requirement

6-9 1.83 14.5

9 - 12 1.15 8.5
12 - 18 0.67 5
18 - 24 0.5 1 3.5
* It was assumed that the requirements for nolmal growth were 1,5 times the theoretical
estimates based on weight gain.
Source: Adapted from WHO, 1985.

I Next, let us learn about the requirements of older children and adolescents.

2.6.2 Energy Requirement for Children and Adolescent

I The preschool years represent the age from approximately 1 to 6 years. Marked
variability exists between requirements during the preschool years because of variation
in growth and physical activity. Energy needs for growth have two components: 1)
h e energy used to synthesize growing tissues; and 2) the energy deposited in those
tissues, basically as fat and protein, because carbohydrate content is negligible. Dietary
energy recommendations also include recommendations for physical activity compatible
with maintenance of health and optimal growth and maturation. The WHOFA01
UNU and the ICMR Expert Committee took note of the fact that Indian children are
smaller at birth, infancy, childhood and adolescence but suggested that it is desirable
that the growth potential of children should be fully expressed and that the estimates
 of energy and protein requirement should allow for this. However, as the normal
Indian children are smaller and they weigh less, the actual energy requirements may
be substantially lower. The dietary intakes thus recommended by ICMR for Indian
children are presented in Table 2.7. You would have noticed that the energy needs
for preschoolers is given in two categories: 1-3 years and 4-6 years.
%Me 2.7: Energy requirement for Indian children and adolescent

Group Particulars Body Weight (kg) Net Energy (Kcalld)

Children 1-3 years 12.2 1240

4-6 years 19.0 1690
7-9 Years 26.9 1650
Adolescerlt
Boys 10-12 years 35.4 2190
Girls 10-12 years 31.5 1970
Boys 13-15 years 47.8 2450
Girls .13-15 years 46.7 2060
Boys 16-18 years 57.1 2640
Girls 16-18 years 49.9 2060

Source: ICMR, 1988.

Marked variability exists 'for boys and girls in the energy requirements after 9 years
. of age because of variations in growth rate and physical activity levels. Marked
gender differences in intensity and duration of the adolescent growth spurt in fat free
mass (FFM) dictates higher energy needs in boys than girls. Hence energy
requirements are specified separately for boys and girls after the age of 9 years as
you can see in Table 2.7.

The energy requirements for adolescents are based on estimates of energy expenditure
and requirements for growth based on tissue deposition. Dietary energy
recommendations also include recorninendations for physical activity compatible with
health, prevention of obesity, and appropriate social and psychological development.
In adolescents, growth is relatively slow except around the adolescent growth spurt,
which varies considerably in timing and magnitude among individuals between 10 and
19 years. Adolescents gain 30 percent of their adult weight and more than 20
percent of their adult height between 10 and 19 years. TLaking into account, the
desirability of achieving full potential for growth, ICMR has used NCHS/well-to-do
Indian children's body weight for computing RDA for adolescents as given in
Table 2.7.

However, children from the poorer segments of the population in India are shorter
and weigh less. It is unlikely that any extra food at this stage can accelerate or
extend the duration of physical growth. Additional dietary intake at this period can
only lead to adolescent obesity. The new ICMR Expert Committee for RDA, which
is already working on revising the requirements for Indians, may have to take all
these into account and evolve appropriate recommendations for dietary intake in
Indian adolescents.

Occupational and recreational activities variably affect energy requirements. The

WHO/FAO/UNU 2004 recommendations, have taken this into consideratio11 and
energy requirements are calculated for children over five years of age and for
adolescents with lifestyles involving three levels of habitual physical activity as
enumerated herewjth:
 Examples of populations with light physical lifestyles, or that are less active than Human Energy
Requirements
average, are children and adolescents who every day spend several hours at school
or in sedentary occupations; do not practice physical sports regularly; generally use
motor vehicles for transportation; and spend most leisure time in activities that require
little physical effort, such as watching television, reading, using computers or playing
I. without much body displacement.
Examples of populations with vigorous lifestyles, or that are more active than
average, are children and adolescents who walk long distances every day or use
bicycles for transportation; engage in high energy-demanding occupations, or perform
high energy-demanding chores for several hours each day; and/or practise sports or
exercise that demand a high level of physical effort for several hours, several days
of the week.

Children and adolescents with habitual physical activity that is more strenuous than
the examples given for a light lifestyle, but not as demanding as the examples for
vigorous lifestyle, would qualify in the categoly of average or morlerate physically
active lifestyles.

Table 2.8 and 2.9 presents the energy requirements for boys and girls (WHO/FAO/
UNU 2004) in populations with these three levels of habitual physical activity.

Table 2.8: Boys' energy requirements in populations with three levds of habitual physical activity
Light Phycial Acfivity Moderate Pl~yfiicalActivity Heavy Pl~ysicnlActivity
Age Weight Daily Energy Requirement I'AI, Daily Energy Requircmcnt PAL Dnily Energy Recluircment PAL
Years Kg MJId KcaVd ILJkp,hI KeoVkglcl MJW KcuVcl KJ&ld KcPMcglcI MI/* Kcnlld KJ/kdd Keoykdd

1-2 11.5 4.0 950 345 82 1.45

2-3 13.5 4.7 1125 350 84 1.45

3-4 15.7 5.2 1250 335 80 1.45

4-5 17.7 5.7 1350 320 77 1.50

5-6 19.7 6.1 1475 310 74 1.55

6-7 21.7 5.6 1350 260 62 1.30 6.6 1575 305 73 1.55 7.6 1800 350 84 1.80

7-8 24.0 6.0 1450 250 60 1.35 7.1 1700 295 71 1.60 8.2 1950 340 81 1.85

8-9 26.7 6.5 1550 245 59 1.40 7.7 1825 285 69 1.65 8.8 2100 330 79 1.90

9-10 29.7 7.0 1675 235 56 3.40 8.3 1975 280 67 1.65 9.5 2275 320 76 1.90

10-11 33.3 7.7 1825 230 55 1.45 9.0 2150 270 65 1.70 10.4 2475 310 74 1.95

11-12 37.5 8.3 2000 220 53 1.50 9.8 2350 260 62 1.75 11.3 2700 300 72 2.00

12-13 42.3 9.1 2175 215 51 1.55 10.7 2550 250 60 1,80 12.3 2925 290 69 2.05

13-14 47.8 9.8 2350 205 49 1.55 11.6 2775 240 58 1,80 13.3 3175 275 66 2.05

14-15 53.8 10.6 2550 200 48 1.60 12.5 3000 235 56 1.85 14.4 3450 270 65 2.15

15-16 59.5 11.3 2700 190 45 1.60 13.3 3175 225 53 1.85 15.3 3650 260 62 2.15

16-17 64.4 11.8 2825 185 44 1.55 13.9 3325 215 52 1.85 16.0 3825 245 59 2.15

17-18 67.8 12.1 2900 180 43 1.55 14.3 3400 210 50 1.85 16.4 3925 240 57 2.15
A

Note:
Body weight at mid-point of age interval (WHO, 1983). Numbers rounded to the closest 0.1 MJ/d, 25 Kcalfd, SKT/kg/d,
Moderate physical activity, MJ/d = (1.298 + 1 Kcal/kg/d, 0.05 PAL unit.
0.265 kg - 0.001 1 kg" + 8.6 KJ/g daily weight gain. Light physical activity: 15% < moderate physical activily.
Vigorous physical activity: 15% > moderate physical activity. PAL = TEE/(Predicted BMRId).
Source: Torun, 2001.
 Advance Nutrition Table 2.9 : Girls' energy requirement in populations with three levels of habitual physical
activity
II
Light Physical Activity Moderate Physical Activity Heavy Physical Activity
Age Weight Daily Energy Requiren~ent PAL Daily Energy Requirement PAL Daily Energy Requirement PAL
"f! Yenrs Kg MJId KcaVd KJwd Kcallkgfd MJId KmUd KJnyld I<camg/d MJ/d KcnVd K J W d KeJUkdd

91 1-2 10.8 3.6 850 335 80 1.40

5E 2-3 13.0 4.4 1050 335 81 1.40

f;r 3-4 15.1 4.8 1150 320 77 1.45
Si 4-5 16.8 5.2 1250 310 74 1.50
5-6 18.6 5.6 1325 300 72 1.55
111 6-7 20.6 5.1 1225 245 59 1.30 6.0 1425 290 69 1.55 6.9 1650 335 80 1.80
7-8 23.3 5.5 1325 235 57 1.35 6.5 1550 280 67 1.60 7.5 1775 320 77 1.85

8-9 26.6 6.0 1450 225 54 1.40 7.1 1700 265 64 1.65 8.2 1950 305 73 1.90

9-10 30.5 6.6 1575 215 52 1.40 7.7 1850 255 61 1.65 8.9 2125 295 70 1.90
10-11 34.7 7.1 1700 205 49 1.45 8.4 2000 240 58 1.70 9.6 2300 275 66 1.95
11-12 39.2 7.6 1825 195 47 1.50 9.0 2150 230 55 1.75 10.3 2475 265 63 2.00

12-13 43.8 8.1 1925 185 44 1.50 9.5 2275 215 52 1.75 11.0 2625 245 60 2.00
13-14 46.3 8.5 2025 175 42 1.50 10.0 2375 205 49 1.75 11.4 2725 235 57 2.00
14-15 52.1 8.7 2075 165 40 1.50 10.2 2450 195 47 1.75 11.8 2825 225 54 2.00
15-16 55.0 8.9 2125 160 39 1.50 10.4 2500 190 45 1.75 12.0 2875 220 52 2.00

16-17 56.4 8.9 2125 160 38 1.50 10.5 2500 185 44 1.75 12.0 2875 215 51 2.00
17-18 56.7 8.9 2125 155 37 1.45 10.5 2500 185 44 1.70 12.0 2875 215 51 1.95

Note:
Body weight at mid-point of age interval (WHO, 1983). Number rounded to the doses 0.1 MJId, 25 Kcalld, 5WIkgld,
Moderate physical activity, MJId = (1.102 + 1 KcalMJId, 0.05 PAL unit
0,273 kg - 0.0019 kg 2) + 8.6 KJIg daily weight gain. Light physical activity: 15% < moderate physical activity.
Vigorous physical activity: 15% > moderate physical activity. PAL = TEEl(Prec1icted BMRId).
Soulce: Ton~n,2001.

Compared with previous estimates (WHOLFAOAJNU 1985), energy requireinents

thus proposed by this consultation are on average 18 percent lower for boys and 20
percent lower for girls under seven years of age, and 12 and 5 percent lower, respectively,
for boys and girls seven to ten years of age. From 12 years onwards, the proposed
requirements are an average of 12 percent higher for both boys and girls.
Next, we move on to the energy requirement for the adults.

2.6.3 Energy Requirement of Adults

The energy needs of Indian men and women for different activity levels c~inputed
on the basis of reco~nmendationsmade by ICMR are shown in Table 2.10.

For computing RDA, the ICMR has taken body weight of 'reference man' as 60 kg
and that of woman' as 50 kg. Average weight of Indian men, howevel; is 52 kg and
women 44 kg. In view of these, it is likely that the energy requirement of Indians is
likely to be substantially lower (about 10-12% lower) than the current ICMR
recommendations as highlighted in Table 2.10. The present ICMR recommendations
are therefore likely to be revised.

54
 Table 2.10: ICMR's RDA for energy (reference body weight and actual body weight) Human Energy
Requirements
Ref.Body Actual Body Energy RDA
Weight Weight Acitivity I For Ref. I
For Actual I Percent
Category Body Weight Body Weight Differencc
Sedentary 2425 2115 13
52.0 Moderate 2875 2492 13
Heavy 3800 3293 13
Sedentary 1875 1740 12
44.0 Moderate 2225 1958 12
Heavv 2925 2594 1I
I I
Source: Dr. B.S. Nsu singa Rao-Gopalan Oration 2001.
With increasing age, there are metabolic changes and also reduction in physical
activity and, as a result, the energy requirement of older adults and elderly is substantially
lower than younger adults as highlighted in Figure 2.2(a) and 2.2(b).

II
I II

3 3000 $ 2500
$2000
'8 2000 1500
P 1000 9: 1000
ia so0
P
a2
0 8c 0
4 50 55 60 65 70 75 W 45 50 55 60 65 70
WHO [;~ICMR Weight in Kg WHO ICMR in Kg

(a): Daily average energy (b): Daily averege cnergy

requirement of sedentary males > 60 years. rcquircmcnt of sedentary females >60 Ycars

Figure 2.2: Daily average energy requirement of sedentary adults

Source: 10th Five Yea Plan (2002-2007),Planning Commission, Government of India.
The previous expert consultation (WHO/FAO/LTNU, 1985) classified the PAL of
adult population groups as light, moderate or heavy, depending on their occupational
I
.j
or other work, and multiplied it by the corresponding BMR to arrive at requirements.
1 The recent FAO/WHO/UNU 2004 report considered that the 24-hour PAL should
I
not be based only on the physical effort demanded by occupational work, as there
are people with light occupations who perform vigorous physical activity in their spare
time, and people with heavy work who are quite sedentary the rest of the day.
Therefore, as discussed earlier in section 2.3, (wherein the examples of lifestyles with
different levels of energy demands are enumerated) the new recommendations base
the factorial estimates of energy requirements on the energy expenditure associated
with lifestyles that combine occupational and discretionary physical activities.
Multiplying the PAL value (as given in Table 2.1 earlier for different lifestyles) by the
BMR gives the actual energy requirements. Table 2.11, 2.12, 2.13 and 2.14 gives the
energy requirement as recommended by FAOTWHO/UNU 2004 report for men and
women aged 18 to 29.9 years and 30 to 59.5 years, respectively. The consultation
also suggested that the average energy cost of activities expressed as a multiple of
BMR, or PAR, should be similar for men and women, Further, the report suggests
that the energy requirements for older adults and the elderly should be calculated on
the basis of PALS, just as they are calculated for younger adults. Allowances must
be made for population groups who are more or less active at an advanced age,
rather than using age as the single cut-off point to define energy requirements for the
elderly. Table 2.15 and 2.16 presents the recommendations for elderly male and
female, respectively over 60 years,
The practice of regular physical activity is associated with the maintenance of adequate
body weight, cardiovascular and respiratory health, and fitness and a lower risk of
developing chronic non communicable diseases associated with diet and lifestyle.
Consequently, dietary energy recommendations to satisfy requirements should be
accompanied by recommendations to perform adequate amounts of physical activity
regularly has been strongly advocated by the WHO/FAO/UNU 2004 recommendation.
 Table 2.11: Daily average energy requirement for men aged 18 to 29.9 years*

BNZR Daily energ requirementaccording to BMR factor ( or PAL) and body weight indicated for
Height (m)
Mean
2.05xBMR 2.20xBMR B M valuesb
-

hU KJ/kg Kcal KcaUlsg MJ Wkg Kcal Kcallkg 24.9 21.0 185

50 121' 29 8.8 175 2100 42 9.7 195 2300 46 10.6 210 2 550 51 11.5 230 2750 55 12.4 250 2950 59 13.3 265 3200 64 1.42 1.54 1.64

55 1 1 6 2 8 9.2 170 2200 40 10.2 185 2450 4.4 11.1 200 2650 48 12.1 220 2900 53 13.0 235 3100 57 14.0 255 3350 61 1.49 1.62 1.72

60 111 27 9.7 160 2300 39 10.7 180 2550 43 11.7 195 2800 47 12.7 210 3050 51 13.7 230 3250 55 14.7 245 3500 59 1.55 1.69 1180

65 108 26 10.1 155 2400 37 11.2 170 2650 41 12.2 190 2900 45 13.3 205 3150 49 14.3 220 3450 53 15.4 235 3700 57 1.62 1.76 1.87

70 1 0 4 2 5 10.6 150 2550 36 11.7 165 2800 40 12.8 185 3 0 5 0 44 13.9 200 3300 47 15.0 215 3600 51 16.1 230 3850 55 1.68 1.83 1.95

75 102 24 11.1 145 2650 35 12.2 165 2900 39 13.3 180 3200 42 14.5 195 3450 46 15.6 210 3750 50 16.8 225 4000 53 1.74 1.89 2.01

80 99 24 11.5 145 2750 34 12.7 160 3050 38 13.9 175 3300 41 15.1 190 3600 45 16.3 205 3900 49 17.5 220 4150 52 1.79 1.95 2.08

85 97 23 12.0 140 2850 34 13.2 155 3150 37 14.4 170 3450 41 15.7 185 3750 44 16.9 200 4050 48 18.2 215 4350 51 1.85 2.01 2.14

90 95 23 12.4 140 2950 33 13.7 150 3300 36 15.0 165 3600 40 16.3 180 3900 43 17.6 195 4200 47 18.8 210 4500 50 1.90 2.07 2.21

* Values rounded to closest 0.1 MJId, 5b Kcalld, 5 KJkgld, 1 Kcalkgld.

" BMR calculated for each waight from the equations in Table 2.3. Values of BMR/kg
-
are presented
.
for ease of calculations for those who wish to use different PAL values or different weights.
,IHeight ranges are presented for each mean weight for ease of making dietary energy reco-endation~ to maintain an adequate BM1 based on a population's mean height and PAL. For example,
the reco~nmendedmean energy intake for a male population of this age group with a mean height of 1.70 m and a lifestyle with a m e w PAL of 1.75, is about 11.7 MJ(2800 Kca1)lday or 195 K J ( 4 7 ~ c a l ) k g l d a ~
to maintain an optimun population median of 21.0 (WHOIFAO, 2002), with an indivual range of about 11.l to 12.8 MJ(2650to 3050 Kca1)lday or 185 to 200 KT(44 to 48 Kcal)/kg /day to maintain the individual
BMI limits of 18.5 to 24.9 (WHO, 2000).
Human Energy
Requirements
 Table 2.13: Daily average energy requirementfor women aged 18 to 29.9 years*

* Values rounded to closest 0.1 MJ14 50 KcaVd, 5 KJ/kg/d, 1 KcaVkgId.

BMR calculated for each weight from the equations in Table 2.3. Values of BMRflcg are presented for ease of calculations for those who wish to use different PAL values or different weights.
Height ranges are presented for each mean weight for ease of making dietary energy recommendations to maintain an adequate BMI based on a population's mean height and PAL. For example,
the recommendedmean energy intake for a male population of this age group with a mean height of 1.70 m and a lifestyle with a mean PAL of 1.75, is about 10.1 MJ(2400 Kcal)/day or 170 KJ(40Kcal)/kg/day
to maintain an optimun population median of 21.0 (WHOIFAO, 2002), with an indivual range of about 9.5 to 11.2 MJ(2300 to 2650 Kcal)/day or 160 to 175 KJ(38 to 42 Kcal)/kg /day to maintain the individual
BMI limits of 18.5 to 24.9 (WHO, 2000).
 Table 2.14: Daily average energy requirementfor women aged 30 to 59.9 years*

* Values rounded to closest 0.1 ~ ~ l50dK j 4 4 5 KJ/kg!d, 1 KcaVkg/d.

" BMR calculated for each weight from the equations in Table 2.3. Values of BMR/kg are presented for ease of calculations for those who wish to use different PAL values or different weights.
Height ranges are presented for each mean weight for ease of making dietary energy recommendations to maintain an adequate BMI based on a population's mean height and PAL. For example,
the recommended mean energy intake for a male population of this age group with a mean height of 1.70 m and a lifestyle with a mean PAL of 1.75, is about 9.8 MJ(2350 Kcal)/day or 165 IU(39 Kcal)kg/day
to maintain an optimun population median of 21.0 (WHOIFAO, 2002), with an indivual range of about 9.5 to 10.4 MJ(2250 to 2500 Kcal)/day or 150 to 170 KJ(36 to 41 Kcal)kg /day to maintain the individual
BMI limits of 1 8 5 to 24.9 (WHO, 2000).
 Table 2.15: Daily average energy requirementfor men aged > 60 years*

1 Daily energy requirement according to BMR factor ( or PAL) and body weight indicated
- - - .- -
I Height (rn)for
1.45xBMR 1.6OxBMR X.75xBMR 2.20xBMR BMT valuesb
MI Kl/kg Kcal Kcallkg MI KNkg Kcal Kcaykg MJ KJkg Kcal KcaVkg MI
1.90 xBMR
KJlkg Kcal KcaUkg
2.OSxBMR

MI K J k g Kcal Kcal/kg hlJ KJkg Kcal

,-
Kcaykg 24.9 21.0 IS.5

7.1 140 1700 34 7.9 155 1900 38 8.6 170 2050 41 9.3 185 2250 45 10.1 200 2400 48 10.8 215 2600 52 1.42 1.54 1.64

7.5 135 1800 33 8.2 150 1950 35 9.0 165 2150 39 9.8 180 2350 43 10.6 190 2550 46 11.3 205 2700 49 1.49 1.62 1.72

7.8 130 1850 31 8.6 145 2050 34 9.4 155 2250 38 10.3 170 2450 41 11.1 185 2650 44 11.9 200 2850 48 1.55 1.69 1.80

8.2 125 1950 30 9.0 140 2150 36 9.9 150 2350 36 10.7 165 2550 39 11.6 180 2750 42 12.4 190 2950 45 1.62 1.76 1.87

8.5 120 2050 29 9.4 135 2250 32 10.3 145 2450 35 11.2 160 2650 38 12.1 170 2900 41 13.0 185 3100 44 1.68 1.83 1.95

8.9 120 2150 29 9.8 130 2350 31 34 11.7 155 2800 37 12.6 170 3000 40 13.5 180 3250 43 1.74 1.89 2.01

1
10.7 145 2550
9.2 115 2200 28 10.2 130 2450 31 11.2 140 2650 33 12.1 150 2900 36 13.1 165 3150 39 14.0 175 3350 42 1.79 1.95 2.08

9.6 115 2300 27 10.6 125 2550 30 11.6 135 2750 32 12.6 150 3000 35 13.6 160 3250 38 14.6 170 3500 41 1.85 2.01 2.14

10.0 110 2400 27 11.0 120 2650 29 12.0 135 2850 32 13.1 145 3100 34 14.1 155 3350 37 15.1 170 3600 40 1.90 2.07 2.21

* Values rounded to closest 0.1 MJ/d, 50 Kcad, 5 KJ/kg/d, 1 KcaVkgId.

" BMR calculated for each weight from the equations in Table 2.3. Values of BMRkg are presentd for ease of calculations for those who wish to use different PAL values or different weights.
Height ranges are presented for each mean weight for ease of making dietary energy reco~nendationsto maintain an adequate BMI based on a population's mean height and PAL. For example,
the recommended mean energy intake for a male population of this age group with a mean height of 1.70 m and a lifestyle with a mean PAL of 1.75, is about 9.4 MJ(2250 Kcal)/day or 155 KJ(38 Kcal)lkdda~
to maintain an optimun population median of 21.0 WHOLFAO, 2002), with an indivual range of about 9.0 to 10.3 MJ(215O to 2450 Kcal)/day or 145 to 160 KJ(35 to 39 Kcal)/kg /day to maintain the individual
BMI limits of 18.5 to 24.9 (WHO, 2000).
Human Energy
Requirements
Advance Nutrition 2.6.4 Energy Requirement During Pregnancy
The energy requirements of pregnancy are those needed for adequate maternal gain
to ensure the growth of the foetus, placenta and associated maternal tissues, and to
provide for the increased metabolic demands of pregnancy, in addition to the energy
needed to maintain adequate maternal weight, body composition and physical activity
throughout the gestational period, as well as, for sufficient energy stores to assist in
proper lactation after delivery. Basal metabolism, we learnt, increases during pregnancy
as a result of accelerated tissue synthesis, increased active tissue mass, and increased
cardiovascular and respiratory work. Based on these considerations the ICMR
recommendation during pregnancy is given in Table 2.17. As you may have noticed
the extra energy cost of pregnancy is 300 Kcal during the second and third trimester
of pregnancy. This is over and above the women's habitual energy requirement
before pregnancy. The additional energy allowance could be lowered in cases where
women reduce their activity level during pregnancy.
Table 2.17: Additional energy cost of pregnancy

1 S t Trimester
2ndTrimester
31d Trimester

Now let us look at the FAO/WHO/UNU 2004 recommendations. The FAO/WHO/

UNU 2004 recommendation for the extra energy cost of pregnancy is 85 KcaVday,
285 KcaVday and 475 Kcallday during the first, second and third trimesters, respectively
as highlighted in Table 2.17. There are many societies with a high proportion of non-
obese women who do not seek prenatal advice before the second or third month of
pregnancy. Under these circumstances, this consultation recommends that in such
societies pregnant women increase their food intake by 360 KcaVday in the second
trimester and by 475 KcaYday in the third. Further, not all women have the option
to reduce physical activity during pregnancy. In particular, women belonging to low-
income group from developing countries must often continue a strenuous work pattern
until shortly before delivery. Furthermore, women who are sedentary prior to pregnancy
have little flexibility to reduce their level of physical activity. Consequently, this
consultation does not recommend a reduction in the additional energy allowance for
pregnancy.
Finally let us get to know about the requirement during lactation.

2.6.5 Energy Requirement During Lactation

The energy requirement of a lactating woman is defined as the level of energy intake
from food that will balance the energy expenditure needed to maintain a body weight
and body composition, a level of physical activity and breastmilk production that are
consistent with good health for the woman and her child, and that will allow
economically necessary and socially desirable activities to be performed (assuming
that she resumes her usual level of physical activity soon after giving birth). Table
2.18 presents the energy requirement for lactation. The ICMR has recommended an
additional intake of 550 Kcal during the first six months of lactation and 400 Kcal
during 7-12 inonths of lactation.
l?ible 2.18: RDA's for lactation
Energy (Kcal)/day
ICMR FAOM7HO/UNU (2004)
0-6 months +550 + 600
6-12 months t44Q + 450
 Exclusive breastfeeding is recommended during the six months after delivery, with Human Energy
introduction of complementary foods and continued breastfeeding thereafter. For Requirements
women who feed their infaits exclusively with breastmilk during the first six months
of life, the mean energy cost as recommended by FAOIWHONNU 2004 over the
six-month period is 600 KcaVday (refer to Table 2.18). From the age of six months
onwards, when infants are partially breastfed and milk production is on average
550 g/day, the energy cost imposed by lactation is 450 KcaVday.
It further suggests that well-nourished women with adequate gestational weight gain
should increase their food intake by 505 Kcal/day for the first six months of lactation,
while undernourished women and those with insufficient gestational weight gain
should add to their personal energy demands 675 Kcal/day during the first six
months of lactation. Energy requirements for milk production in the second six months
are dependent on rates of milk production, which are highly variable among woinen
and populations.
With a review of the energy requirement during the different ages and physiological
stages,we end our discussion on the requirements here. Finally, we shall look at the
energy imbalance problems.

2.7 ENERGY IMBALANCE: AN OVERVIEW

Energy balance, we have learnt from our discussion so far, is achieved when input
(i.e. dietary energy intake) is equal to output (i.e. total energy expenditure). When
energy balance is maintained over a prolonged period, an individual is considered to
be in a steady state.
The recommended intake of energy of a group is equal to the average energy
requirement of individuals of the group because both lower and higher energy intakes
are associated with heallh hazards. Too much deviation on either side from the
appropriate range of body weight increases our risk of health problems. Just as
overweight is the result of positive energy balance, underweight results when the
energy balance is negative.
A growing literature supports the use of the body Inass index (BMI) as a predictor
of the impact of body weight on morbidity and mortality risks. BMI, defined as
PC weight in kilograms divided by the square of height in meters, is also termed the
Quetelet's index. It is used in preference to other weightheight indices, including the
weightheight ratio, the Ponderal Index and the Benn's Index as highlighted in
Table 2.19.
pr 'hble 2.19: Indices for weight relative to height
Inlsv Formula
Weight/Height ratio wtlht
Body Mass index (BMI) wt/ (ht)2
Ponderal Index ht13m
Benn's Index wt/(ht)'

The power P in Benn's index is calculated to minimize the direct relationship

with height. Weight in all indices is in kg and height in meters.
BMI, although only an indirect indicator of body composition, is now used to classify
underweight and overweight individuals. Table 2.20 presents the WHO classification
of underweight, overweight and obesity in adults according to BMI.
Advance Nutrition Table 2.20: WHO classification of underweight, overweight and obesity in adults according
to body mass index @MI)
-- - - - - - -- -

Classification B I w (Kdm2z) Risk of Comorbidity

Underweight < 18.5 L~~:I:
Normal range 1 18.5 - 24.9 I Average
Overweight 25 - 29.9 Increascd
Obesity -
> 30.0
Classs 1 30.0 - 34.9 Moderate
Class 11 35.0 - 39.9 Severe
Class 111 (morbid) -
> 40.0 Very Severe
* Low for the non-communicable diseases associated wit11 obesity, but increased mortality
due to cancer and infectious diseases
Source: WHO (1998).
As both underweight and obesity are associated with adverse health consequences,
it has been suggested that each country should develop its own BMI and cut-off
points indicative of various degrees of undernutrition and overnutrition based on their :
own data on health problems in persons with varying BMI levels. It has been found
that for a given BMI, Indians have more body fat than other ethnic groups, both
within and outside Asia. This relative increase in adiposity in Indians has led to the
suggestion that the BMI cut-off for non-communicable diseases such as obesity
should be reduced for Indians to about 23 kg/m2 or lower. In other words, we can
refer to it as a public health action point at a EM1 of 23 kg/m2. The point at which
low BMI poses a health risk is poorly defined. The ability to identify persons with
low BMIs who are at increased risk for morbidity and mortality is highly nonspecific.

Weight status in children can be classified based on percentile curves for BMI for
age. Table 2.21 presents the weight status based on percentile BMI for age. The
latest BMI for age percentile for boys and girls, aged 2-20 years have been published
by the United States Centre for Health Statistics (NCHS) in collaboration with the
National Centre for Chronic Diseases Prevention and Health Promotion in the Year
2000 which may be applied to health of well-nourished Indian children also.

Table 2.21: WHO classification of weight status in children based on percentile curves for
IBMI for age
Weight Status BMI for Age
Underweight i5"' percentile
At risk of overweight > 85"' lo < 95"' percentile
-

Source: WHO Tecl~nicalReport (1995).

From our discussion above,it is clear that the com~nonway to assess undernutrition
or overnutrition (obesity) is in terms of body weight. Uildernutrition is caused by a
less than adequate intake of nutrient, most of which are related to the energy intake.
In adults, this has led to the tenn 'energy deficiency'. Obesity,on the other hand,
is energy imbalance where energy intake exceeds energy expenditure. Let us review
these two conditions, linked to energy imbalance, briefly here.

Chronic Energy Deficiency (CED)

Energy deficiency we have seen refers to less than adequate intake of energy. It is
further sub classified into acute and chronic energy deficiency. Acute energy
deficiency is suspected when an involuntary weight loss of greater than 10% of body
weight occurs over the preceding 3-6 months. We can say it is sudden and associated
with a declining body weight. Chronic energy deficiency (CED), on the other hand, Human Energy
occurs over a long period of time, such that body weight over the preceding few Requirements
months may be low, but stable. It is characterized by low body mass index in weight-
stable individuals.

In 1994, FA0 adopted the term 'chronic energy deficiency' for underweight. They
categolized three degrees of underweight on the basis of BMI as presented in Table
2.22. WHO has adopted the same cut-off as presented in Table 2.22 to define three
grades of low BMI, referred to as 'underweight' (refer to Table 2.22) rather than
'chronic energy deficiency'.
%ble 2.22: FAO/WWO classification for chronic energy deficiency andlor underweight

Chronic Energy Deficiency Grade Underweigl~tGrade BMI

(FA01 (WHO) (kg/m2)

Normal
Grade I Mild Underweight
Grade I1 Moderate Underweight
Grade III Severe Underweight

Energy deficiency is associated with body weight loss along with changes in body
compositioil (both body fat and the fat free mass are decreased), as well as, a
reduced BMR and physical activity. Figure 2.3 illustrates how these factors interact
with each other to attain lower energy expenditure when an acute negative energy
balance exists.

I Negative Energy Balance I

Increased Decreased Physical
metabolic
Activity
Efficiency Energy Stores

I* Decreased BMR
Decreased
Decreased Bocly

I Thermogenesis I

+ v
Lowered Energy Expenditure

Figure 2.3: Factors leading to lowered energy expenditure

Now if the lowered energy expenditure (as illustrated in Figure 2.3) is adequate to
compensate the lowered or decreased energy intake (which was the cause of negative
energy balance in the first place) a new energy balance is achieved which allows a
person to survive, albeit at a lower plane of nutrition and this is what is referred to
as chronic energy cleficierzcy. Thus, you would notice, it is a weight-stable condition,
in the presence of lower than normal energy intake. It is characterized by low body
weight and fat stores, but h e individi~al'shealth is normal and the body's physiological
Advance Nutrition function is also not compromised and therefore the individuals ability to lead an
economically productive life is maintained.

However, the consequences of inadequate energy intake during the childhood and
adolescence of an individual is a reduced body size and a low BMI. In the presence
of concomitant repeated infections in childhood and adolescence, an individual with
CED, will also show stunting. Both the body fat and the fat free mass are decreased
as compared to a normally nourished individual. Reduction in muscle mass leads to
reduced skeletal muscle performance, which may also be partly due to f~~nctional
changes in skeletal muscles. Further adults with CED have lowered handgrip strength
and they also fatigue faster when subjected to standard exercise protocols. Statistics
suggest that nearly 25-50% of adults from developing countries, including India may
be described as having CED. Low values of BMI in adults have been consistently
associated with a ciecline in work output, productivity, and income-generating
ability, as well as, a compronzised ability lo respond to stressful conditions.

Eight percent (8%) of Indians do not get two square meals a day and there are
pockets where severe undernutrition takes its toll even today. Eveiy third child born
is underweight. Around half of the preschool children suffer from undernutrition
problem low birth weight is associated not only with higher infant mortality but also
long-term health consequences including increased risk of non-comnunicable diseases
such as' obesity, diabetes mellitus, coronary heart diseases etc.

Cllronic energy deficiency and undernutrition is a public health problem in India. The
contributory factors include:
@ low dietay intake because of poverty and low purchasing power;
high prevalence of infection because of poor access to safe-drinking water,
sanitation and health care;
poor utilization of available health and other facilities due to low literacy and lack
of awareness.
Next, let us review another energy imbalance condition viz. obesity which is a state
of excess energy intake over expenditure.

Obesity
The World Health Organization has declared obesity as the largest global chronic
health problem in adults, which by 2025 will emerge as a more serious world problem
than undernutrition.
Recent data from National Nutrition Monitoring Bureau (NNMB) repeat surveys
indicate that there has been some reduction in undernutrition and alarmingly some
increase in obesity over the last two decades in India. Data from National Family
Health Survey-2 (NFHS) confinns that currently both undernutrition and oven~utrition
are problems in woinen (Table 2.23)
Table 2.23: Nutritional status of ever married women aged 15-49 Years
EM1 < 18.5 (kg/m3 BMI > 25 (kg/m2)
All India 35.8% 10.6%
Source:NFHS -2 1998-99.

Alterations in lifestyles and dietary intake have led to the increasing incidence of
obesity and associated non-communicable diseases. Obesity results froin an imbalance
between energy intake and energy expenditure. The health risks associated with
obesity include increased mortality, hyperlension, cardiovascular disease, diabetes
mellitus, gallbladder disease, some cancers, and changes insendocrine function and
metabolism. The risk factors for becoming obese are not entirely understood but are
thought to include genetics, food intake, physical inactivity, and some rare metabolic Human Energy
disorders. Obesity rates in all age groups are increasing also mainly because of the Requirements
reduction in physical activity without concomitant reduction in energy intake.'

Energy expenditure by physical adivity varies considerably between individuals,

affecting the energy balance and the body composition by which energy balance and
weight maintenance are achieved. Indeed, physical inactivity is a major risk factor for
development of obesity in children and adults. Therefore, a certain amount of habitual
physical activity is desirable for biological and social well-being. The regular
performance of physical activity by children, in conjunction with good nutrition, is
associated with health, adequate.growt11and well-being, and probably with lower risk
of disease in adult life. There is consensus (FAO/WHO/UNU 2004) that, in order to
promote general health, at least 30 minutes of moderate to vigorous activity should
be performed, three or more days per week.

In view of the known adverse health consequences of both excess and deficient
energy intc&e, it is essential that appropriate recommendation for the RDA for lndians
is evolved. This is impol-tant as the coui~tiyis entering an era of Gual disease burden
of CED and infections on the one hand and that of obesity and non-con~mui~icable
diseases on the other.
Check Your Progress Exercise 2
1) What does the factorial estimation of energy expellditure involve'? Rani is a
female, 25 years of age, wit11 a inoderately active lifestyle and a mean body
weight of 50 kg. Calculate her energy requirements using the factorial approach.
.......................................................................
.............................................

.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
2) Give the energy requirement as reconllnellded by ICMR' and FAOIWHOIUNU
2004 for the following:
Lactating Mothers: .........................................................................................
.....................................................................................................................
Adults: ............................, .........................................................................
.....................................................................................................................
3) comparkI with the values in the FAOIWHOIUNU 1985 report, how are the
energy requirements for infants proposed by FAO/WHO/UNU 2004 consultation
different.
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
4) List two conditions arising due to energy imbalance. What are the consequences
of these conditio~is?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
Advance Nutrition
2.7 LET US SUM #UP
In this unit we learnt about the human energy requirements. Energy requirement we
learnt 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, and to allow optimal growth and development of children, deposition
of tissues during pregnancy, and secretion of milk during lactation, consistent with
long-term good health. For healthy, well-nourished adults, it is equivalent to total
energy expenditure (TEE). The total energy expenditure over a 24-hour period is the
sum of basal metabolic rate (BMR), thermic effect of feeding (TEF), physical activity
and the energy cost of tissue synthesis.

Further, we studied that the energy needs vary widely among individuals in a group.
A number of factors cause the BMR to vary among individuals. Major determinants
are the body size, composition, age, sex, growth etc. Similarly, there are factors
affecting the thermic effect of food and energy expended in physical activity which
influence energy requirements.

When energy balance is maintained over a prolonged period, an individual is considered

to be in a steady state. However, too inuch deviation on either side from the appropriate
range of body weight, either due to intakes in excess of requirements or intakes lower
than requirements, increases our risk of health problems. Just as overweight (obesity)
is the result of positive energy balance, undernutrition (chronic energy deficiency)
results when the energy balance is negative.

2.8 GLOSSARY ,

Glycogenolysis : catabolism of glycogen leading to glucose availability.

Sepsis : serious medical condition, resulting from the immune

response to a severe infection.

2.9 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
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Check Your Progress Exercise 1

1) Energy in simple terms may be defined as the ability, or power, to do work.

A kilocalorie is defined as the amount of heat required to raise the temperature
of 1 kg of water through lo Celsius (centigrade).
The amount of heat energy (kilocalorie) per gram that can be made available
to the body by each ofthe energy-yielding macronutrients - carbohydrate (1 g
yields 4 Kcal), protein (1 g yields 4 Kcal), fat (1 g yields 9 Kcal) is known as
the physiological fuel factor.
The metabolic processes ( such as ingestion and digestion of food, the absorption,
transport, interconversion, oxidation and deposition of nutrients) increase heat
productioil and oxygen consumption, and are known as by term 'therrnic effect
of feeding' (TEF).
2) The total energy expenditure over a 24-hour period is the sum of BMR, TEF,
and energy for physical activities. For adults, this is equivalent to daily energy
requirements. Additional energy for deposition in growing tissues is needed to
determine energy requirements in infancy, childhood, adolescence and during
pregnancy, and for the production and secretion of milk during lactation.
 3) The amount of energy used for basal metabolism, which includes a series of Human Energy
functions that are essential for life, such as cell function and replacement; the Requirements
synthesis, secretion and metabolism of enzymes and hormones to transport
proteins and other substances and molecules; the maintenance of body temperature;
uninterrupted work of cardiac and respiratory muscles; and brain function, in a
period of time is called the basal metabolic rate (BMR).The factors which
influence BMR include fat free mass (FFM),fat mass (FM), age, sex, hormonal
status, nutritional status, growth, diseaselinfections etc.
4) The different lifestyle classifications with their PAL values are as follows;.

Category PAL Value

Sedentary or light activity lifestyle 1.40 - 1.69
Active or moderate1 activity lifestyle 1.70 - 1.99
Vigorous or heavy activity lifestyle 2.00 - 2.40"

Check Your Progress Exercise 2

1) The factorial estimation of energy expenditure involve summation of all the
expected components of energy expenditure, including BMR and taking into
account the energy costs of different activities and their durations.
Energy requirement for Rani can be calculated as:
From the Table 2.3, BMR calculated "from the predictive equation is: 1227.5
Kcallday) (i.e. 14.818 x 50 + 486.6 = 1227.5).
PAL from mid-point of the moderately active lifestyle in Table 2.1 is: 1.85.
TEE or Energy requirement: 1227.5 x 1.85 = 2271 Kcallday), or 2271150
= 45 KcaVkgIday).
2) The energy requirements for lactation as given by ICMR and FAOIWHO are
presented in Table 2.18. Look up the values and write on your own,
The energy requirements for adults as given by ICMR and FAOIWHO are
presented in Table 2.10, 2.11, 2.12, 2.13 and 2.14. Look up the values and write
on your own.
3) Compared with the values in the FAOIWHOIUNU 1985 report, energy
requirements proposed by FAOTWHONNU 2004 consultation are about 12
1 percent lower in the first three months of life, 17 percent lower from three to
nine months, and 20 percent lower from nine to 12 months. The requirements
for breastfed infants are 17, 20 and 22 percent lower than the 1985 estimates
at ages 0 to three, three to nine and nine to 12 months, respectively.
I
4) The two conditions arising due to energy imbalance are chronic energy deficiency
and obesity. Consequences of inadequate energy intake during the childhood and
adolescence of an individual result in a reduced body size and a low BMI. In
the presence of concomitant repeated infections in childhood and adolescence,
an individual with CED, will also show stunting, reduction in muscle mass leading
to reduced skeletal muscle performance, The health risks associated with obesity
1 include increased mortality, hypertension, cardiovascular disease, diabetes mellitus,
i gallbladder disease, some cancers, and changes in endocrine function and
metabolism.