Validation of Dietary Reference Intakes for predicting energy requirements in elementary school-age children

BACKGROUND/OBJECTIVES: Dietary Reference Intakes (DRI) for energy are derived from total energy expenditure (TEE) measured using the doubly labelled water (DLW) method. The objective of this study was to assess the validity of DRI for predicting the energy requirements of elementary school-age children. SUBJECTS/METHODS: The present study involved 25 elementary school-age children aged between 9 and 11 years. TEE was assessed by the DLW method, and the results were compared with the TEE predicted by the DRI equations in order to evaluate accuracy. RESULTS: The subjects' TEE measured by the DLW method was $1,925.2{\pm}380.9kcal/day$ in boys and $1,930.0{\pm}279.4kcal/day$ in girls, whereas resting energy expenditure was $1,220.2{\pm}176.9kcal/day$ in boys and $1,245.9{\pm}171.3kcal/day$ for girls. The physical activity level was $1.58{\pm}0.20$ in boys and $1.55{\pm}0.13$ in girls. The mean bias between the predicted and measured TEE was 12.6% in boys and -1.6% in girls, and the percentage of accurate predictions was 28.6% and 63.6%, respectively. In boys, the equation resulted in underprediction of TEE among the subjects having low TEE values, whereas there was overprediction among subjects having high TEE values as shown by the Bland-Altman plot. On the contrary, this proportional bias was not observed in girls. CONCLUSIONS: The findings of this study suggest that the DRI equation for energy could result in the overestimation of energy requirements in elementary school-age boys. In the case of girls, the equations could be accurate at the group level. However, the DRI appears to be invalid for individual girls, as more than one third of girls had their TEE inaccurately predicted. We recommend more studies for confirmation of these results.