Shuar REE was measured in triplicate on days 0, 7, and 14 using a validated Quark RMR respirometry system (COSMED, Rome) with a canopy hood. Five children were measured only twice. Measurements were performed in a quiet room in the supine position, with parents nearby. All measures were made in the morning (mean ± SD = 06:43 ± 43 min), following overnight fast (mean ± SD = 12.4 ± 1.5 hours reported fast), and before strenuous physical activity. Device calibration was performed before each measure using a manufacturer-provided standard gas mixture and volume syringe. Child O2 consumption and CO2 production were monitored continuously for ≥30 min, with the first 10 min of data discarded and the remaining steady-state period averaged to determine REE using the modified Weir equation (37). Overall, reliability of repeated weekly REE measures was high [coefficient of variation (CV) = 6.4%], with the average of weekly values representing final REE. Model results were similar when analyzing conservative values of Shuar REE that excluded initial or single highest repeated measures (table S4).

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