Introduction: Evaluation of total energy expenditure (TEE) and physical activity level (PAL) is important for treatment of patients with type 2 diabetes mellitus (T2DM). However, the validity of accelerometers (ACC) and physical activity questionnaires (PAQ) for estimating TEE and PAL remains unknown in elderly populations with T2DM. We evaluated the accuracy of TEE and PAL results estimated by an ACC (TEEACC and PALACC) and a PAQ (TEEPAQ and PALPAQ) in elderly patients with T2DM. Methods: Fifty-one elderly patients with T2DM (aged 61–79 years) participated in this study. TEEACC was calculated with PALACC using a triaxial ACC (Active style Pro HJA-750c) over 2 weeks and predicted basal metabolic rate (BMR) by Ganpule’s equation. TEEPAQ was estimated using predicted BMR and the PALPAQ from the -Japan Public Health Center Study-Long questionnaire. We compared the results to TEEDLW measured with the doubly labeled water (DLW) method and PALDLW calculated with BMR using indirect calorimetry. Results: TEEDLW was 2,165 ± 365 kcal/day, and TEEACC was 2,014 ± 339 kcal/day; TEEACC was strongly correlated with TEEDLW (r = 0.87, p < 0.01) but significantly underestimated (–150 ± 183 kcal/day, p < 0.05). There was no significant difference in TEEPAQ and TEEDLW (–49 ± 284 kcal/day), while the range of difference seemed to be larger than TEEACC. PALDLW, PALACC, and PALPAQ were calculated to be 1.71 ± 0.17, 1.69 ± 0.16, and 1.78 ± 0.24, respectively. -PALACC was strongly correlated with PALDLW (r = 0.71, p < 0.01), and there was no significant difference between the 2 values. PALPAQ was moderately correlated with PALDLW (r = 0.43, p < 0.01) but significantly overestimated. Predicted BMR was significantly lower than the BMR -measured by indirect calorimetry (1,193 ± 186 vs. 1,262 ± 155 kcal/day, p < 0.01). Conclusions: The present ACC and questionnaire showed acceptable correlation of TEE and PAL compared with DLW method in elderly patients with T2DM. Systematic errors in estimating TEE may be improved by the better equation for predicting BMR.

1.
Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998 Jul;339(4):229–34.
2.
Cui R, Iso H, Yamagishi K, Saito I, Kokubo Y, Inoue M, et al. Diabetes mellitus and risk of stroke and its subtypes among Japanese: the Japan public health center study. Stroke. 2011 Sep;42(9):2611–4.
3.
Kato M, Noda M, Mizoue T, Goto A, Takahashi Y, Matsushita Y, et al.; JPHC Study Group. Diagnosed diabetes and premature death among middle-aged Japanese: results from a large-scale population-based cohort study in Japan (JPHC study). BMJ Open. 2015 May;5(4):e007736.
4.
Sasaki A, Horiuchi N, Hasegawa K, Uehara M. Mortality and causes of death in type 2 diabetic patients. A long-term follow-up study in Osaka District, Japan. Diabetes Res Clin Pract. 1989 Jun;7(1):33–40.
5.
Tancredi M, Rosengren A, Svensson AM, Kosiborod M, Pivodic A, Gudbjörnsdottir S, et al. Excess Mortality among Persons with Type 2 Diabetes. N Engl J Med. 2015 Oct;373(18):1720–32.
6.
Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006 Dec;444(7121):860–7.
7.
Okamura T, Miki A, Hashimoto Y, Kaji A, Sakai R, Osaka T, et al. Shortage of energy intake rather than protein intake is associated with sarcopenia in elderly patients with type 2 diabetes: A cross-sectional study of the -KAMOGAWA-DM cohort. J Diabetes. 2019 Jun;11(6):477–83.
8.
Westerterp KR, Brouns F, Saris WH, ten Hoor F. Comparison of doubly labeled water with respirometry at low- and high-activity levels. J Appl Physiol (1985). 1988 Jul;65(1):53–6.
9.
Schoeller DA. Recent advances from application of doubly labeled water to measurement of human energy expenditure. J Nutr. 1999 Oct;129(10):1765–8.
10.
Plasqui G, Bonomi AG, Westerterp KR. Daily physical activity assessment with accelerometers: new insights and validation studies. Obes Rev. 2013 Jun;14(6):451–62.
11.
Sasai H, Nakata Y, Murakami H, Kawakami R, Nakae S, Tanaka S, et al. Simultaneous Validation of Seven Physical Activity Questionnaires Used in Japanese Cohorts for Estimating Energy Expenditure: A Doubly Labeled Water Study. J Epidemiol. 2018 Oct;28(10):437–42.
12.
Csizmadi I, Neilson HK, Kopciuk KA, Khandwala F, Liu A, Friedenreich CM, et al. The Sedentary Time and Activity Reporting Questionnaire (STAR-Q): reliability and validity against doubly labeled water and 7-day activity diaries. Am J Epidemiol. 2014 Aug;180(4):424–35.
13.
Calabro MA, Kim Y, Franke WD, Stewart JM, Welk GJ. Objective and subjective measurement of energy expenditure in older adults: a doubly labeled water study. Eur J Clin Nutr. 2015 Jul;69(7):850–5.
14.
Westerterp KR. Physical activity and physical activity induced energy expenditure in humans: measurement, determinants, and effects. Front Physiol. 2013 Apr;4:90.
15.
Miyake R, Ohkawara K, Ishikawa-Takata K, Morita A, Watanabe S, Tanaka S. Obese Japanese adults with type 2 diabetes have higher basal metabolic rates than non-diabetic adults. J Nutr Sci Vitaminol (Tokyo). 2011;57(5):348–54.
16.
Bogardus C, Taskinen MR, Zawadzki J, Lillioja S, Mott D, Howard BV. Increased resting metabolic rates in obese subjects with non-insulin-dependent diabetes mellitus and the effect of sulfonylurea therapy. Diabetes. 1986 Jan;35(1):1–5.
17.
Fontvieille AM, Lillioja S, Ferraro RT, Schulz LO, Rising R, Ravussin E. Twenty-four-hour energy expenditure in Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1992 Aug;35(8):753–9.
18.
Bitz C, Toubro S, Larsen TM, Harder H, Rennie KL, Jebb SA, et al. Increased 24-h energy expenditure in type 2 diabetes. Diabetes Care. 2004 Oct;27(10):2416–21.
19.
Sallé A, Ryan M, Ritz P. Underreporting of food intake in obese diabetic and nondiabetic patients. Diabetes Care. 2006 Dec;29(12):2726–7.
20.
Chong PK, Jung RT, Rennie MJ, Scrimgeour CM. Energy expenditure in lean and obese diabetic patients using the doubly labelled water method. Diabet Med. 1993 Oct;10(8):729–35.
21.
Chong PK, Jung RT, Rennie MJ, Scrimgeour CM. Energy expenditure in type 2 diabetic patients on metformin and sulphonylurea therapy. Diabet Med. 1995 May;12(5):401–8.
22.
Morino K, Kondo K, Tanaka S, Nishida Y, Nakae S, Yamada Y, et al. Total energy expenditure is comparable between patients with and without diabetes mellitus: Clinical Evaluation of Energy Requirements in Patients with Diabetes Mellitus (CLEVER-DM) Study. BMJ Open Diabetes Res Care. 2019 Mar;7(1):e000648.
23.
Schoeller DA, Ravussin E, Schutz Y, Acheson KJ, Baertschi P, Jéquier E. Energy expenditure by doubly labeled water: validation in humans and proposed calculation. Am J Physiol. 1986 May;250(5 Pt 2):R823–30.
24.
Kobayashi S, Murakami K, Sasaki S, Okubo H, Hirota N, Notsu A, et al. Comparison of relative validity of food group intakes estimated by comprehensive and brief-type self-administered diet history questionnaires against 16 d dietary records in Japanese adults. Public Health Nutr. 2011 Jul;14(7):1200–11.
25.
Black AE, Prentice AM, Coward WA. Use of food quotients to predict respiratory quotients for the doubly-labelled water method of measuring energy expenditure. Hum Nutr Clin Nutr. 1986 Sep;40(5):381–91.
26.
Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949 Aug;109(1-2):1–9.
27.
Oshima Y, Kawaguchi K, Tanaka S, Ohkawara K, Hikihara Y, Ishikawa-Takata K, et al. Classifying household and locomotive activities using a triaxial accelerometer. Gait Posture. 2010 Mar;31(3):370–4.
28.
Ohkawara K, Oshima Y, Hikihara Y, Ishikawa-Takata K, Tabata I, Tanaka S. Real-time estimation of daily physical activity intensity by a triaxial accelerometer and a gravity-removal classification algorithm. Br J Nutr. 2011 Jun;105(11):1681–91.
29.
Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al.; SBRN Terminology Consensus Project Participants. Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017 Jun;14(1):75.
30.
Fujii H, Yamamoto S, Takeda-Imai F, Inoue M, Tsugane S, Kadowaki T, et al. Validity and applicability of a simple questionnaire for the estimation of total and domain-specific physical activity. Diabetol Int. 2011;2(2):47–54.
31.
Ganpule AA, Tanaka S, Ishikawa-Takata K, Tabata I. Interindividual variability in sleeping metabolic rate in Japanese subjects. Eur J Clin Nutr. 2007 Nov;61(11):1256–61.
32.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb;1(8476):307–10.
33.
Crouter SE, Horton M, Bassett DR Jr. Use of a two-regression model for estimating energy expenditure in children. Med Sci Sports Exerc. 2012 Jun;44(6):1177–85.
34.
Colbert LH, Matthews CE, Havighurst TC, Kim K, Schoeller DA. Comparative validity of physical activity measures in older adults. Med Sci Sports Exerc. 2011 May;43(5):867–76.
35.
Bassett DR Jr, Ainsworth BE, Swartz AM, Strath SJ, O’Brien WL, King GA. Validity of four motion sensors in measuring moderate intensity physical activity. Med Sci Sports Exerc. 2000 Sep;32(9 Suppl):S471–80.
36.
Whitcher L, Papadopoulos C. Accelerometer Derived Activity Counts and Oxygen Consumption between Young and Older Individuals. J Aging Res. 2014;2014:184693.
37.
Irwin ML, Ainsworth BE, Conway JM. Estimation of energy expenditure from physical activity measures: determinants of accuracy. Obes Res. 2001 Sep;9(9):517–25.
38.
Bouten CV, Verboeket-van de Venne WP, Westerterp KR, Verduin M, Janssen JD. Daily physical activity assessment: comparison between movement registration and doubly labeled water. J Appl Physiol (1985). 1996 Aug;81(2):1019–26.
39.
Westerterp KR. Pattern and intensity of physical activity. Nature. 2001 Mar;410(6828):539.
40.
Falconer CL, Page AS, Andrews RC, Cooper AR. The Potential Impact of Displacing Sedentary Time in Adults with Type 2 Diabetes. Med Sci Sports Exerc. 2015 Oct;47(10):2070–5.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.