Energy expenditure of stunted and nonstunted boys and girls living in the shantytowns of Sao Paulo, Brazil

Background: Stunting increases the risk of obesity in developing countries, particularly in girls and women, but the underlying reason is not known. Objective: Our objective was to test the hypothesis that stunted children have lower energy expenditure than do nonstunted children, a factor that has predicted an increased risk of obesity in other high-risk populations. Design: A cross-sectional study was conducted in shantytown children from Sao Paulo, Brazil. Twenty-eight stunted children aged 8-11 y were compared with 30 nonstunted children with similar weight-for-height. Free-living total energy expenditure (TEE) was measured over 7 d by using the doubly labeled water method. In addition, resting energy expenditure (REE) was measured by indirect calorimetry and body composition was measured by dual-energy X-ray absorptiometry. Results: There were no significant associations between stunting and any measured energy expenditure parameter, including REE adjusted for weight (x̄ ± SEM: 4575 ± 95 compared with 4742 ± 91 kJ/d, in stunted and nonstunted children, respectively) and TEE adjusted for weight (8424 ± 239 compared with 8009 ± 221 kJ/d, in stunted and nonstunted children, respectively). In multiple regression models that included fat-free mass and fat mass, girls had significantly lower TEE than did boys (P < 0.05) but not significantly lower REE (P = 0.17). Conclusions: There was no association between stunting and energy expenditure after differences between groups in body size and composition were accounted for. However, the girls had lower TEE than did boys, which may help to explain the particularly high risk of obesity in stunted adolescent girls and women in urban areas of developing countries.