The purpose of the present paper is to review recent studies in children which have: (1) examined differences in energy expenditure, especially as they relate to differences in body composition and risk of developing obesity; (2) enabled more accurate measurements of body composition (especially fat and fat-free mass) and body fat distribution (especially intra-abdominal adipose tissue); (3) examined the relationship between obesity (especially body fat distribution) and increased disease risk.
ENERGY EXPENDITUREImplementation of the doubly-labelled-water technique in human subjects in 1984 (Schoeller & Webb, 1984), and subsequent application in children has led to significant advances in our understanding of total energy expenditure in the paediatric population. Total energy expenditure has been measured in free-living children living in Phoenix, Arizona (Fontvieille et al. 1993), Burlington, Vermont (Goran et al. 1993a), Cambridge, UK (Prentice et al. 1988;Davies et al. 1994), and Belfast, Northern Ireland (Livingstone et al. 1992). The data are unanimous in showing that total energy expenditure in young children is approximately 25 % lower than current recommendations for energy intake (World Health Organization, 1985). This discrepancy may be explained by either: (1) inaccuracy of previous energy intake data used to derive the recommendations, or (2) a reduction in energy expenditure in children over the last few decades, presumably due to a decline in physical activity. Either way, these data imply that new nutritional guidelines need to be formulated for young children in order to ensure that recommended energy intake closely matches total energy expenditure. This may require reducing recommended levels of energy intake or recommending increased physical activity in order to reverse the recent cultural trends of reduced physical activity.Studies of energy expenditure in children have also been useful for examining the role of energy expenditure in the development of obesity. Obesity arises from a failure in the regulation of energy balance leading to a mismatch between energy intake and energy expenditure, such that intake exceeds expenditure. The mechanism of this dysregulation is unknown, and it is not clear whether obesity develops because of an excess in energy intake relative to expenditure, a reduced energy expenditure relative to intake, or a https://www.cambridge.org/core/terms. https://doi