ESPE2021 ePoster Category 2 Fat, metabolism and obesity (59 abstracts)
Resting energy expenditure and body composition in children and adolescents with severe obesity due to (suspected) medical causes: comparison between different subtypes of obesity
Ozair Abawi 1,2 , Emma Koster 2,3 , Mila Welling 1,2,4 , Sanne Boeters 2,3 , Elisabeth van Rossum 2,4 , Bibian van der Voorn 1,2,4 , Cornelis de Groot 1,2,5 & Erica van den Akker 1,2
1Dept. of Pediatrics, div. of Endocrinology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands; 2Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; 3Dept. of Dietetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; 4Dept. of Internal Medicine, div. of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; 5Dept. of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, Netherlands
Background: Paediatric obesity is a multifactorial disease characterized by an imbalance between energy intake and expenditure. In rare cases, obesity is caused by underlying medical disorders arising from disruptions in the leptin-melanocortin pathway, which regulates satiety and energy expenditure.
Aim: To investigate resting energy expenditure (REE) in relation to body composition in children and adolescents with severe obesity with (suspected) medical causes.
Methods: For this prospective observational study, we included patients who underwent an extensive diagnostic workup in our academic paediatric obesity centre. This included genetic testing, assessment of hypothalamic and medication-induced causes of obesity, REE measurement by indirect calorimetry (QUARK RMR) and body composition by air displacement plethysmography (BODPOD). The ratio between measured REE (mREE) in kcal/day and predicted REE (Schofield formula) is expressed as REE%, with lowered mREE defined as REE% ≤90%. Additionally, the ratio between mREE and fat-free-mass (FFM) was calculated. Associations of mREE/FFM with age and BMI SDS were investigated.
Results: In total, n = 285 patients with severe obesity were included, of which in 65 (23%) an underlying medical cause was identified (Table). Mean age was 10.7 ± 4.4 years, 60% were female, mean BMI SDS was 3.7 ± 1.1. REE characteristics are presented in the Table. Across all patients, mREE was positively associated to FFM (r = 0.87, P < 0.001), whereas mREE/FFM was negatively associated with age (r = -0.65, P < 0.001), but not BMI SDS (r = -0.00, P = 0.98).
| All patients (n = 285) | Non-syndromic genetic obesity (n = 28) | Syndromic genetic obesity (n = 27) | Hypothalamic obesity (n = 6) | Medication-induced obesity (n = 4) | Idiopathic obesity (n = 220) | |
| mREE kcal/day | 1706 (499) | 1860 (655) | 1475 (358) | 1523 (285) | 1517 (229) | 1645 (523) |
| REE% | 100.1 (13.6) | 104.5 (14.6) | 98.5 (9.0) | 91.6 (17.6) | 91.1 (20.3) | 99.9 (13.7) |
| Lowered mREE | 60 (21%) | 4 (14%) | 5 (19%) | 2 (33%) | 1 (25%) | 48 (22%) |
| mREE/FFM kcal/day/kg | 46.8 (10.8) | 45.9 (10.2) | 50.8 (14.8) | 42.0 (7.1) | - | 46.5 (10.4) |
| Data presented as mean (SD) or count (%). | ||||||
Conclusions: We present the REE characteristics of a large cohort of patients with severe obesity due to (suspected) medical causes, which on group level were similar in children with an underlying medical cause and with idiopathic severe obesity. In a substantial number of patients, a lowered REE was found. This knowledge can aid in developing patient-tailored treatment approaches, e.g. personalized dietary plans and/or pharmacologic treatment affecting central energy expenditure regulation such as glucagon-like peptide-1 receptor agonists and dexamphetamine.
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