Comparison of Handheld to Metabolic Cart Indirect Calorimetry for Resting Energy Expenditure Assessment in Extremely Obese Women

The Deltatrac Metabolic Monitor (DTC), one of the most popular indirect calorimetry systems for measuring resting metabolic rate (RMR) in human subjects, is no longer being manufactured. This study compared five different gas analysis systems to the DTC. Resting metabolic rate was measured by the DTC and at least one other instrument at three study sites for a total of 38 participants. The five indirect calorimetry systems included: MedGraphics CPX Ultima, MedGem, Vmax Encore 29 System, TrueOne 2400, and Korr ReeVue. Validity was assessed using paired t-tests to compare means while reliability was assessed by using both paired t-tests and root mean square calculations with F tests for significance. Within-subject comparisons for validity of RMR revealed a significant difference between the DTC and Ultima. Bland-Altman plot analysis showed significant bias with increasing RMR values for the Korr and MedGem. Respiratory exchange ratio (RER) analysis showed a significant difference between the DTC and the Ultima and a trend for a difference with the Vmax (p = 0.09). Reliability assessment for RMR revealed that all instruments had a significantly larger coefficient of variation (CV) (ranging from 4.8% to 10.9%) for RMR compared to the 3.0 % CV for the DTC. Reliability assessment for RER data showed none of the instrument CV's were significantly larger than the DTC CV. The results were quite disappointing, with none of the instruments equaling the within person reliability of the DTC. The TrueOne and Vmax were the most valid instruments in comparison with the DTC for both RMR and RER assessment. Further testing is needed to identify an instrument with the reliability and validity of the DTC.Correspondence and request for reprints: Dr. Dale Schoeller,

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“…Exclusion criteria have been described previously (5). The study was approved by the IRB at the UMN, and subjects gave written, informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…Subject preparation and testing procedures have been described elsewhere (5). DTC measurements spanned 20 minutes and the first five minutes were discarded.…”

Section: Methodsmentioning

confidence: 99%

Assessing Validity and Reliability of Resting Metabolic Rate in Six Gas Analysis Systems

Cooper

Watras²,

O’Brien³

et al. 2009

Journal of the American Dietetic Association

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180

161

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“…IC was used in three studies to compare measured and predicted energy expenditure (23–25). One study made a comparison between energy expenditure by handheld IC vs. metabolic cart (26). The remaining articles were studies among morbidly obese patients that used IC methodologies before and after surgical or weight loss intervention or exercise testing.…”

Section: Resultsmentioning

confidence: 99%

Resting energy expenditure of morbidly obese patients using indirect calorimetry: a systematic review

et al. 2012

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The increasing proportion of acutely ill hospital patient admissions presenting with a morbidly obese body mass index (BMI ≥ 40 kg m(-2) ) as a comorbidity is an emerging clinical concern. Suboptimal food intake and malnutrition is prevalent in the acute care hospital setting. The energy requirements necessary to prevent malnutrition in acutely ill patients with morbid obesity remains unclear. The aim of this systematic review was to identify studies in the literature that have used indirect calorimetry to measure the resting energy expenditure of patients with morbid obesity to establish their minimum energy requirements and the implications for optimal feeding practices in acutely ill hospitalized patients. A total of 20 studies from PubMed, Cochrane Library and Embase met the inclusion criteria and were reviewed. All articles were graded using the Australian National Health and Medical Research Council levels of evidence and given a quality rating using the American Dietetic Association recommendations. Studies were categorized according to the mean BMI of its subjects. The most commonly measured resting energy expenditures for morbidly obese patients are between 2,000 and 3,000 kcal d(-1) (8,400-12,600 kJ d(-1) ). Activity and injury factors of acutely ill morbidly obese patients could result in significantly greater energy requirements for this patient group and are unlikely to be met by standard hospital menus. Establishing the minimum energy requirements for this population group will help inform adequate and accurate energy provision in the acute setting. Outcomes of underfeeding and overfeeding in morbidly obese patients warrant further research.

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“…Multiple studies in healthy populations of all ages show handheld calorimeters are accurate (± 1%) compared to the metabolic cart 11 – 15 . However, studies conducted in hospitalized patients and field studies in developing countries identified disparities of up to ± 300 calories when REE measured by handheld calorimeter was compared with the metabolic cart 16 – 19 . Accurate measurement with a handheld calorimeter requires a trained staff as well as patient adherence to testing procedures.…”

Section: Predictive Equations Used To Compare Energy Expenditure In 1mentioning

confidence: 99%

Energy Expenditure in Acute Posttraumatic Amputation

2013

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Comparison of Handheld to Metabolic Cart Indirect Calorimetry for Resting Energy Expenditure Assessment in Extremely Obese Women

Cited by 3 publications

References 28 publications

Assessing Validity and Reliability of Resting Metabolic Rate in Six Gas Analysis Systems

Assessing Validity and Reliability of Resting Metabolic Rate in Six Gas Analysis Systems

Resting energy expenditure of morbidly obese patients using indirect calorimetry: a systematic review

Energy Expenditure in Acute Posttraumatic Amputation

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