Estimating resting energy expenditure in patients requiring nutritional support: a survey of dietetic practice

Green, A J; Smith, Pete; Whelan, Kevin

doi:10.1038/sj.ejcn.1602690

Cited by 12 publications

(11 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overestimation of the severity of metabolic stress may have led to the application of higher stress factors to energy prescription in our cohort. A wide range of stress factors are incorporated into the estimates of energy requirements in an attempt to account for the increased energy burden of hypermetabolic states (37). However, these factors are applied inconsistently in clinical practice and the reasons for choosing a particular stress factor in individual cases are not clear.…”

Section: Discussionmentioning

confidence: 99%

Energy imbalance and the risk of overfeeding in critically ill children*

Mehta

Bechard

Dolan

et al. 2011

Pediatric Critical Care Medicine

121

102

View full text Add to dashboard Cite

Objective To examine the role of targeted indirect calorimetry in detecting the adequacy of energy intake and the risk of cumulative energy imbalance in a subgroup of critically ill children suspected to have alterations in resting energy expenditure. We examined the accuracy of standard equations used for estimating resting energy expenditure in relation to measured resting energy expenditure in relation to measured resting energy expenditure and cumulative energy balance over 1 week in this cohort. Design A prospective cohort study. Setting Pediatric intensive care unit in a tertiary academic center. Interventions A subgroup of critically ill children in the pediatric intensive care unit was selected using a set of criteria for targeted indirect calorimetry. Measurements Measured resting energy expenditure from indirect calorimetry and estimated resting energy expenditure from standard equations were obtained. The metabolic state of each patient was assigned as hypermetabolic (measured resting energy expenditure/estimated resting energy expenditure >110%), hypometabolic (measured resting energy expenditure/estimated resting energy expenditure <90%), or normal (measured resting energy expenditure/estimated resting energy expenditure = 90– 110%). Clinical variables associated with metabolic state and factors influencing the adequacy of energy intake were examined. Main Results Children identified by criteria for targeted indirect calorimetry, had a median length of stay of 44 days, a high incidence (72%) of metabolic instability and alterations in resting energy expenditure with a predominance of hypometabolism in those admitted to the medical service. Physicians failed to accurately predict the true metabolic state in a majority (62%) of patients. Standard equations overestimated the energy expenditure and a high incidence of overfeeding (83%) with cumulative energy excess of up to 8000 kcal/week was observed, especially in children <1 yr of age. We did not find a correlation between energy balance and respiratory quotient (RQ) in our study. Conclusions We detected a high incidence of overfeeding in a subgroup of critically ill children using targeted indirect calorimetry The predominance of hypometabolism, failure of physicians to correctly predict metabolic state, use of stress factors, and inaccuracy of standard equations all contributed to overfeeding in this cohort. Critically ill children, especially those with a longer stay in the PICU, are at a risk of unintended overfeeding with cumulative energy excess.

show abstract

Section: Discussionmentioning

confidence: 99%

Energy imbalance and the risk of overfeeding in critically ill children*

Mehta

Bechard

Dolan

et al. 2011

Pediatric Critical Care Medicine

121

102

View full text Add to dashboard Cite

show abstract

“…Energy requirements were calculated using the Henry equation , with the addition of appropriate stress and activity factors. A 10% stress factor was given for infection in the absence of pneumonia and septicaemia to reduce overestimation. Protein requirements were calculated from estimated nitrogen requirements .…”

Section: Methodsmentioning

confidence: 99%

“…Energy requirements were calculated using the Henry equation (24) , with the addition of appropriate stress and New menu with main meal at lunchtime and a lighter, bistro-style evening meal consisting of a soup, sandwich, salad, jacket potato and a hot dessert Increased number of choices at lunch time, with more hot options including a roast dinner option every day A new sandwich supplier providing a wider range of fillings Provision of more energy-dense options Increased range of snacks available including cakes, scones, thick and creamy and low-fat yoghurts, biscuits, fruit pots, cheese and crackers New printed menu folders displaying dietary coding including energydense options and information about accessing food outside of mealtimes Increased engagement of ward staff at mealtimes to help with meal service and assist patients Reinforcement of protected meal times Annual 'Making Mealtimes matter' campaigns to promote quality food service and provision Secured funding for a Food Services Dietitian to act as a link between dietitians, catering staff and ward teams (appointed August 2017) activity factors. A 10% stress factor was given for infection in the absence of pneumonia and septicaemia (34) to reduce overestimation. Protein requirements were calculated from estimated nitrogen requirements (33) .…”

Section: Estimated Individual Requirementsmentioning

confidence: 99%

Improving the nutritional intake of hospital patients: how far have we come? A re‐audit

Beavan

Baker

Sadler

et al. 2018

J Human Nutrition Diet

View full text Add to dashboard Cite

Background Malnutrition affects up to 33.6% of hospitalised patients, with consequences that are detrimental for both patients and healthcare providers. In 2015, an audit demonstrated inadequate nutritional provision and consumption by hospitalised patients, comprising a major risk factor for malnutrition. This re‐audit evaluates whether patients are meeting recommended energy and protein standards and estimated individual requirements, subsequent to food service improvements since 2015. Methods Patients (n = 111) were included from a South West hospital, and Malnutrition Universal Screening Tool scores (MUST) categorised patients as ‘nutritionally well’ (MUST 0) or ‘nutritionally vulnerable’ (MUST ≥ 1). Individual energy and protein requirements were estimated using weight‐based equations. Nutritional intakes were assessed via 24‐h dietary recall and compared against the British Dietetic Association's Nutrition and Hydration Digest standards, as well as estimated individual requirements. Results In total, the Digest standards for energy and protein were met by 35% and 63% of patients respectively, which is an increase of 19% and 36% since 2015. ‘Nutritionally well’ patients were more likely to meet nutrient standards for protein (62%) than estimated individual requirements (30%) (P ≤ 0.001). ‘Nutritionally vulnerable’ patients were more likely to meet estimated individual requirements for energy (60%) than the Digest standards (30%) (P = 0.047). Conclusions The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein‐dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice.

show abstract

“…Future research should aim to identify the barriers to screening in this setting because our previous work has shown that training alone is insufficient to achieve improved NST completion rates. Background: Many methods are available to determine energy requirements; however, all have limitations and their use in clinical practice is variable and not universally understood (Green et al, 2008). Estimating energy requirements of obese patients is particularly problematic (Breen et al, 2004).…”

mentioning

confidence: 99%

“…An opportunistic sample was recruited via e-mail providing a link to the survey (contact details openly available on NHS Trust websites) and through the online newsletter of the British Dietetic Association. The anonymous online questionnaire was developed specifically for this project by dietitians working in nutrition support and was based on the structure of two previous surveys (Reeves et al, 2003;Green et al, 2008). Respondents were asked to estimate energy requirements using two theoretical case scenarios: one patient was obese and one was not.…”

mentioning

confidence: 99%

Estimating energy requirements in obese and non-obese patients: a survey of dietetic practice in the United Kingdom

Judges

Graham

Knight

et al. 2011

Journal of Human Nutrition and Dietetics

View full text Add to dashboard Cite

Background: Many methods are available to determine energy requirements; however, all have limitations and their use in clinical practice is variable and not universally understood (Green et al., 2008). Estimating energy requirements of obese patients is particularly problematic (Breen et al., 2004). The aim of the current survey was to investigate current practice in the estimation of energy requirements in an obese and non‐obese patient in a large cohort of UK dietitians. Methods: A cross‐sectional web‐based survey of UK Registered Dietitians was performed. An opportunistic sample was recruited via e‐mail providing a link to the survey (contact details openly available on NHS Trust websites) and through the online newsletter of the British Dietetic Association. The anonymous online questionnaire was developed specifically for this project by dietitians working in nutrition support and was based on the structure of two previous surveys (Reeves et al., 2003; Green et al., 2008). Respondents were asked to estimate energy requirements using two theoretical case scenarios: one patient was obese and one was not. Demographic information including training, experience and job role were also collected. Data were analysed using SPSS, version 18 (SPSS Inc., Chicago, IL, USA); chi‐squared tests for independence, Kruskal–Wallis and Mann–Whitney U‐tests were performed. Results: Six hundred and seventy‐two responses were received from all areas of the UK. For the non‐obese patient, prediction equations and adjustment for metabolic stress and physical activity was used by 90.3% of respondents. The median estimated energy requirement was 8704 kJ (2079 kcal) [interquartile range (IQR): 8122–9295 kJ (1940–2220 kcal)] day−1. The median target volume of feed prescribed was 2000 (IQR: 2000–2000) mL day−1; significantly less than estimated requirements (P < 0.001). Estimated energy requirement using kcal/kg method was significantly lower compared to the equations method: 7536 kJ (1800 kcal) [range: 2428–10798 kJ (580–2579 kcal)] versus 8704 kJ (2079 kcal) [range: 2428–12385 kJ (580–2958 kcal)] day−1 (P < 0.001). For the obese patient, prediction equations to estimate basal metabolic rate (BMR) alone was used by 50.7% of respondents. Nutrition support dietitians used a lower stress factor compared to non‐nutrition support dietitians (10.3 ± 6.3 versus 13.6 ± 6.05 %; P = 0.016). The method used to estimate energy requirements was associated with years in clinical practice (P < 0.001); those in practice <5 years were more likely to use BMR alone when estimating energy requirements for the obese patient compared to those in practice >10 years. Respondents used a significantly lower kcal kg−1 for the obese patient (25 (IQR: 20–30) kcal kg−1) compared to the non‐obese patient (30 (IQR: 25–35) kcal kg−1) (P = 0.014). Discussion: This survey found the majority of respondents used prediction equations to estimate energy requirements which is similar to the results of previous surveys (Green et al., 2008). Many more respondents used BMR al...

show abstract

Estimating resting energy expenditure in patients requiring nutritional support: a survey of dietetic practice

Cited by 12 publications

References 9 publications

Energy imbalance and the risk of overfeeding in critically ill children*

Energy imbalance and the risk of overfeeding in critically ill children*

Improving the nutritional intake of hospital patients: how far have we come? A re‐audit

Estimating energy requirements in obese and non-obese patients: a survey of dietetic practice in the United Kingdom

Contact Info

Product

Resources

About