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Comparison of total energy expenditure and energy intake in children aged 6–9 y^1,2,3

¹ From the Department of Paediatrics and Child Health, University of Sydney, Australia; the James Fairfax Institute of Paediatric Nutrition, The Children's Hospital at Westmead, Westmead, Australia; Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, Australia; and the Queensland University of Technology, Kelvin Grove, Australia.

Background: The accurate measurement of food intake in children is important for assessing nutritional status.

Objective: We sought to both compare measurements of energy intake (EI) from diet records and of total energy expenditure (TEE) by the doubly labeled water (DLW) method and to investigate misreporting of EI.

Design: Forty-seven children (22 boys and 25 girls) aged 7.4 ± 0.8 y ( ± SD) were recruited from 25 schools in western Sydney. TEE was measured by DLW over 10 d and EI by use of 3-d food records. Misreporting was defined as [(EI - TEE)/TEE] x 100%.

Results: Girls had a higher (P = 0.02) percentage of body fat (28.2 ± 7.0%) than did boys (22.9 ± 8.0%); otherwise there were no differences among sex. Although mean (±SD) values for EI (7514 ± 1260 kJ/d) and TEE (7396 ± 1281 kJ/d) were not significantly different, there was no significant correlation between EI and TEE. EI and TEE were 9% and 11% lower, respectively, than current World Health Organization recommendations for EI. The relative bias (mean difference, EI - TEE) was low at 118 kJ/d, but the limits of agreement (bias ± 2 SD of the difference) were wide at 118 ± 3345 kJ/d. Although the mean percentage of misreporting was low (4 ± 23%), the high SD indicates large intraindividual differences between EI and TEE. The most significant predictor of misreporting was dietary fat intake (r² = 0.45, P < 0.0001). Misreporting was not associated with sex or body composition.

Conclusions: In this age group, reported EI is not representative of TEE at the individual level. However, at the population level, 3-d food records may be used for surveys of EI by 6–9-y-old children.

Key Words: Food record • dietary energy intake • doubly labeled water • energy expenditure • children • misreporting • macronutrients • dietary fat • Sydney • Australia