Energy expenditure estimation in recipients of marrow transplants

Hutchinson, Martha L.; Clemans, Gordon W.; Springmeyer, Steven C.; Flournoy, Nancy

doi:10.1002/1097-0142(19841015)54:8<1734::aid-cncr2820540844>3.0.co;2-0

Cited by 21 publications

(14 citation statements)

References 15 publications

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“…Variations in measured REE during HSCT have previously been reported in adults and children 11-14 . In a group of 6 children undergoing autologous HSCT for malignant disease, mean REE was 111% of predicted BMR in those receiving PN before high dose chemotherapy conditioning, and 128% of predicted BMR in those receiving PN after conditioning 13 .…”

Section: Discussionmentioning

confidence: 75%

Attenuation of resting energy expenditure following hematopoietic SCT in children

Bechard

Feldman

Venick

et al. 2012

Bone Marrow Transplant

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Background Children undergoing hematopoietic stem cell transplantation (HSCT) typically receive parenteral nutrition (PN) due to gastrointestinal toxicities. Accurate determination of resting energy expenditure (REE) may facilitate optimal energy provision and help avoid unintended overfeeding or underfeeding. Methods In a multicenter, prospective cohort study of children undergoing allogeneic HSCT, REE was measured by indirect calorimetry at baseline and twice weekly until 30 days after transplantation. Change in percent predicted REE over time from admission was analyzed using repeated measures regression analysis. Results Twenty-six children (14 females) with a mean (SD) age of 14.9 (4.2) years who underwent an HLA-matched sibling or unrelated donor transplantation were enrolled. Mean (SD) percent predicted REE at baseline was 92.4 (15.2). Baseline REE was highly correlated with lean body mass measured by DXA (r=0.78, p<.0001). REE decreased significantly over time, following a quadratic curve to a nadir of 79% predicted at 14 days post transplantation (p <0.001) and returned to near baseline by day 30. Conclusions Children undergoing HSCT exhibit a significant reduction in REE in the early weeks after transplantation, a phenomenon that places them at risk for overfeeding. Serial measurements of REE or reductions in energy intake should be considered when PN is the primary mode of nutrition.

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Section: Discussionmentioning

confidence: 75%

Attenuation of resting energy expenditure following hematopoietic SCT in children

Bechard

Feldman

Venick

et al. 2012

Bone Marrow Transplant

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“…Szeluga et al 4 reported that the energy requirements of the six children they studied increased during HSCT. Hutchinson et al 26 reported an average energy requirement 5% above that estimated by the Harris-Benedict equation, with individual patients' needs ranging from 79% to 121% of the estimate. Others report that individuals undergoing HSCT have energy requirements 1.3 to 1.5 times those obtained by using the Harris-Benedict equation.…”

Section: Discussionmentioning

confidence: 99%

Energy expenditure in children undergoing hematopoietic stem cell transplantation

Ringwald-Smith

Heslop

Krance

et al. 2002

Bone Marrow Transplant

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Summary:Prior studies suggest that patients undergoing hematopoietic stem cell transplantation (HSCT) for malignancy have nutritional needs that are greater than their estimated needs. To determine whether energy estimation equations accurately predict energy expenditure of pediatric patients undergoing HSCT, we prospectively compared the estimated energy expenditure (EEE) and measured energy expenditure (MEE) of 40 patients at four time-points. We also investigated whether energy requirements changed during the transplant period. MEE was determined by indirect calorimetry. Data from 34 patients (autologous HSCT = 10, allogeneic HSCT = 24) were sufficient for analysis. The World Health Organization equation adequately approximated MEE only on day 14 after HSCT. At all other timepoints, measured energy expenditure was significantly less than estimated energy expenditure obtained by using the WHO equation (applicable to all patients), the Seashore equation (for patients Ͻ15 years of age; n = 19), or the Harris-Benedict equation (for patients у15 years of age; n = 15). The median measured energy expenditure varied significantly over the study period and was greatest on day 14 after HSCT. Until accurate equations have been identified for estimating these patients' needs, the use of indirect calorimetry may be medically warranted. Medical nutrition therapy is an important part of the management of hematopoietic stem cell transplantation (HSCT) in children. During the transplant period, numerous factors can alter nutritional requirements. First, the intense chemotherapy and, in some cases, radiation given before transplantation may cause tissue damage, mucositis, nausea and vomiting, and diarrhea, any of which may increase caloric requirements or lead to protein catabolism.1-3 Second, graft-versus-host disease (GVHD), which often follows allogeneic HSCT, may increase energy requirements and lead to a negative nitrogen balance. 4 Third, the energy requirements of children are increased by the demands of physical growth. Therefore, the goals of medical nutrition therapy in this patient population are to restore or maintain lean body mass, to provide the nutrients needed for recovery of the hematopoietic and immune systems, and to facilitate normal growth and development. 5Prior studies, most of which were conducted in adults undergoing HSCT, revealed that energy needs change throughout the course of transplantation and that patients appear to expend more energy than is estimated by standard predictive equations. 4,6,7 Energy expenditure may be determined by standard estimation equations and through the use of indirect calorimetry. Indirect calorimetry can be extremely useful in the daily nutritional management of hospitalized patients who are at risk for nutritional depletion and who may be suffering from catabolic stress as a result of infection, trama, or treatment complications. 8To date, the energy requirements of pediatric patients undergoing HSCT have not been systematically studied. We prospectively compared the ...

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“…With regard to energy requirements, estimates are at around 130-150% (30-35 kcal/kg/day) of the basic theoretical energy expenditure [75,80,81]. The contribution of protein via the enteral route is estimated at about 0.2 g/kg unless the patient has a BMI of <30 kg/m 2 , in which case it must be reduced to 75%.…”

Section: Nutritional Indications During Mucositis Associated With Hemmentioning

confidence: 99%

ADI nutritional recommendations for dysphagia

Barbiera

Bosetti

Ceravolo

et al. 2009

Mediterr J Nutr Metab

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Energy expenditure estimation in recipients of marrow transplants

Cited by 21 publications

References 15 publications

Attenuation of resting energy expenditure following hematopoietic SCT in children

Attenuation of resting energy expenditure following hematopoietic SCT in children

Energy expenditure in children undergoing hematopoietic stem cell transplantation

ADI nutritional recommendations for dysphagia

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