An evaluation of resting energy expenditure in hospitalized, severely underweight patients

Ahmad, Arif; Duerksen, Donald R.; Munroe, Scott; Bistrian, Bruce R.

doi:10.1016/s0899-9007(99)00068-4

Cited by 49 publications

(33 citation statements)

References 20 publications

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“…This result is similar to other studies, which have compared this prediction method with measured BMR, showing that predictions underestimated true requirements (Hunter et al, 1988;Ahmad et al, 1999). Studies comparing measured BMR to BMR predicted by the Harris-Benedict equations in healthy adults have indicated that the equations consistently overestimate requirements, ranging from 104.8 to 113.5% (Daly et al, 1985;Owen et al, 1986Owen et al, , 1987Foster et al, 1988;Mifflin et al, 1990;Case et al, 1997).…”

Section: Discussionsupporting

confidence: 88%

Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice

Reeves

Capra

2003

Eur J Clin Nutr

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Objective: To determine current methods used by dietitians for estimating the energy requirement of a chronically and acutely ill adult patient and the variation in the application of methods. Design: A cross-sectional survey including a case study. Setting: Acute care adult hospitals in Australia. Subjects: A total of 307 dietitians (66.2% response rate). Intervention: Surveys were posted to hospitals. A reminder letter was sent to all hospitals 2 weeks after the initial posting and a follow-up survey was sent 6 weeks after the initial posting to non-respondents. Results: Respondents calculated a mean energy requirement for the case study of 978071410 kJ/day. One-third of respondents calculated energy requirement within 7500 kJ of the mean. Respondents primarily used the Schofield equations (67.4%) followed by the Harris-Benedict equations (25.9%) to estimate energy requirement. Estimates using the Schofield equations calculated the highest mean energy requirement. The median injury factor used in the calculations was 1.3 (1.0-1.5). The values and reasons for the selection of injury factors varied widely. Calculated energy requirement did not differ with the aims of nutritional careFmaintaining current weight (970071370 kJ/day) or increasing weight (979071380 kJ/day). Conclusion: There was considerable variation in the methods and factors used for estimating energy requirement, resulting in a wide range of calculated requirements. The application of prediction methods to individuals in acute care does not appear to be universally understood among dietitians. Dietitians require an understanding of the correct application, appropriate use, and limitations of these prediction methods.

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Section: Discussionsupporting

confidence: 88%

Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice

Reeves

Capra

2003

Eur J Clin Nutr

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“…A nonzero intercept was observed, however, suggesting that the association is curvilinear [9]. When expressed in relation to body weight, REE was higher than controls (31.30 AE 2.14 versus 25.07 AE 1.00 kcal/kg/day; P < 0.01) [7 ], indicating that the energy requirements of undernourished patients is greater than that of normal individuals [10]. Refeeding resulted in improvement in REE (28.90 AE 1.85 kcal/kg/day).…”

Section: Metabolic Consequences Of Starvationmentioning

confidence: 99%

“…Increased REE, expressed per unit body weight, does not necessarily indicate reduced metabolic efficiency. Body tissues contribute differentially to REE [9], and this increase may reflect changes in body composition, with reduction in the relatively low energy consuming tissues, fat and muscle, and preservation of the metabolically active visceral protein and nervous tissue [7 , 10,21]. There appears to be a variable adaptive response to chronic undernutrition [21].…”

Section: Metabolic Consequences Of Starvationmentioning

confidence: 99%

The effects of undernutrition and refeeding on metabolism and digestive function

Winter

2006

Current Opinion in Clinical Nutrition and Metabolic Care

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“…Most commonly used formulas for nutrition include the Harris-Benedict equation and an empiric formula of resting energy expenditure ϭ 25 kcal/kg per day. [5][6][7] Challenges exist in assessing patients at either end of the weight spectrum. In critically ill obese patients it has been suggested that the metabolic response to injury is different than in non-obese people.…”

mentioning

confidence: 99%

“…8 -10 Commonly used predictive equations routinely underestimate the energy needs of severely underweight patients (Ͻ50 kg). 5 The cachectic appearance of patients in the ICU may also result in a tendency to overcompensate in providing energy. This patient population is at the highest degree of nutritional risk, with the greatest potential for benefit from appropriate nutritional support.…”

mentioning

confidence: 99%

Energy Requirements in Critically Ill Patients: How Close Are Our Estimates?

Alberda

Snowden²,

McCargar³

et al. 2002

Nut in Clin Prac

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A retrospective analysis of 55 mechanically ventilated critically ill patients was conducted to determine adequacy of nutritional support (total parenteral nutrition or enteral nutrition) according to requirements established by indirect calorimetry. Patients who received 90% to 110% of the established energy requirements as measured by indirect calorimetry were defined as adequately fed. At the time of the indirect calorimetry measurements, all patients were receiving their targeted nutritional support, as assessed by the unit dietitian, who used predictive formulas to assess patients. Indirect calorimetry results showed that 25% of the patients were overfed (receiving >110% of energy requirements), 35% were underfed (receiving <90% of energy requirements), and 40% were adequately fed (receiving 90% to 110% of energy requirements). We determined that critically ill patients with a body mass index <20 kg/m2 were the most likely group to be assessed inappropriately by available regression equations. If indirect calorimetry measurement is unavailable, we suggest using an empiric formula of 37 kcal/kg for critically ill patients with a body mass index <20 kg/m2.

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An evaluation of resting energy expenditure in hospitalized, severely underweight patients

Cited by 49 publications

References 20 publications

Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice

Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice

The effects of undernutrition and refeeding on metabolism and digestive function

Energy Requirements in Critically Ill Patients: How Close Are Our Estimates?

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