MethodsDoubly labeled water validation of a computerized use-of-time recall in active young people
Introduction
The prevalence of childhood overweight and obesity is high in developed countries [1], though recent evidence suggests rates are no longer increasing [2]. Obesity has been linked with increased risk of metabolic syndrome and risk factors for cardiovascular disease in young people [3], [4], [5]. In New Zealand, more than one third of young people aged 5–24 years are overweight or obese [6].
Because of its potential to increase daily energy expenditure, regular physical activity may be an important modifiable lifestyle behavior for both the prevention and treatment of childhood obesity [7], [8], though the impact of physical activity on overall energy balance remains a topic of debate [9], [10]. Furthermore, decreasing time spent being sedentary (engaging in sitting or lying activities associated with low levels of energy expenditure) has emerged as another potential target to promote energy balance and maintain optimal body composition. Sedentary behavior in children and young people has been independently linked with adverse health outcomes including increased metabolic risk [11] and obesity [12], [13].
For the purposes of measurement, free-living energy expenditure has been conceptualized as a time-series that is sampled to give an indication of overall behavior [14]. Daily AEE describes the energy cost of all waking activities (both physically active and sedentary) above rest. TEE reflects the total energy expended by the body and includes AEE as well as resting metabolic rate and the thermic effect of feeding [15]. Self-report measures such as questionnaires are a popular approach for the assessment of physical activity and to estimate daily energy expenditure due to their practicality and lower cost [16], as well as their potential to offer rich information regarding the type and context of the activity.
The evolution of “use-of-time” tools is an important development for the estimation of daily energy expenditure from self-report. These tools require participants to retrospectively recall all daily activities, in contrast with traditional self-report tools that focus on selected activities such as moderate to vigorous physical activity. Multiple outcomes may be assessed simultaneously, including both physical activity and sedentary behavior. Because use-of-time tools account for all activities performed in a specified time period, they are considered to have greater potential for estimating daily energy expenditure than traditional self-report tools [17], [18]. However, all self-report tools are prone to recall and social desirability biases [19] and rely on approximations in estimating the energy cost of various activities.
The MARCA is a computerized use-of-time tool that has been validated for use in young people. This tool has indicated adequate psychometric properties in preliminary validation research [20], [21], and has been used in population-based surveys conducted in Australia [22] and New Zealand [6]. However, this tool has not been validated against DLW, the criterion (gold) standard for the measurement of free-living energy expenditure. Therefore, the aim of this study was to validate the MARCA against DLW for the estimation of TEE and AEE in young people.
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Participants
A convenience sample of young people (n = 32) aged 10–18 years were recruited between September 2009 and May 2010. Recruitment occurred by word of mouth, and primarily included young people from local sports clubs. Participants were required to understand English and be able to provide informed consent (or parental consent). Participants with contra-indications to exercise were excluded.
Sample size
A total of 50 participants were targeted in this study. It was assumed that the true correlation between the
Results
Thirty-two participants aged 10–18 years were recruited and completed study procedures. Despite extensive efforts, it was not possible to achieve the recruitment target of 50 participants. However, this sample is similar to previous DLW validation studies of similar tools [34], [35], [36], [37], [38], [39]. Baseline characteristics of participants are presented in Table 2. Twenty-seven (84%) participants self-classified as New Zealand European, four participants self-classified as Māori
Discussion
Compared to the criterion standard of DLW, the MARCA indicated moderate validity for the prediction of daily TEE and AEE in this sample of physically active young people. The MARCA over-estimated TEE and under-estimated AEE by an average of 50 and 105 kcal/day, respectively. There was a small bias between methods, though the limits of agreement were large for both variables. Medium to strong correlation coefficients were found between the MARCA and DLW. For both TEE and AEE, the variability
Author contributions
LF, RM, ER, TO and KR were involved in the conception and design of the study. LF collected the data. YJ designed and conducted the analysis. All authors contributed to the interpretation of data. LF drafted the article, and all authors were responsible for revising it critically for important intellectual content. All authors gave final approval of the version to be published.
Funding
LF was supported by a Tertiary Education Commission Bright Futures Doctoral Scholarship, and is currently supported by a Heart Foundation Postdoctoral Fellowship. RM was supported by a Heart Foundation Fellowship. This study was supported by grants from Sport and Recreation New Zealand, the Heart Foundation and the University of Auckland.
Conflict of interest
Disclosure statement: The authors declare that there are no conflicts of interest.
Acknowledgments
The authors wish to gratefully acknowledge the contribution of the participants to this research.
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