Indirect calorimetry: The 6 main issues

Achamrah, N.; Delsoglio, Marta; Waele, Elisabeth De; Berger, Mette M.; Pichard, Claude

doi:10.1016/j.clnu.2020.06.024

Cited by 57 publications

(50 citation statements)

References 46 publications

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“…A human RQ of 1.0, 0.8, and 0.7 represents glucose, protein, and fat oxidation, respectively [ 23 , 25 , 30 , 58 ]. The physiological range of the RQ is 0.67-1.3; therefore, it can also be used as a quality indicator of the measurement adequacy [ 59 – 61 ]. The approximate respiratory quotient of a mixed oral diet is 0.8.…”

Section: Indirect Calorimetrymentioning

confidence: 99%

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

2021

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The use of indirect calorimetry is strongly recommended to guide nutrition therapy in critically ill patients, preventing the detrimental effects of under- and overfeeding. However, the course of energy expenditure is complex, and clinical studies on indirect calorimetry during critical illness and convalescence are scarce. Energy expenditure is influenced by many individual and iatrogenic factors and different metabolic phases of critical illness and convalescence. In the first days, energy production from endogenous sources appears to be increased due to a catabolic state and is likely near-sufficient to meet energy requirements. Full nutrition support in this phase may lead to overfeeding as exogenous nutrition cannot abolish this endogenous energy production, and mitochondria are unable to process the excess substrate. However, energy expenditure is reported to increase hereafter and is still shown to be elevated 3 weeks after ICU admission, when endogenous energy production is reduced, and exogenous nutrition support is indispensable. Indirect calorimetry is the gold standard for bedside calculation of energy expenditure. However, the superiority of IC-guided nutritional therapy has not yet been unequivocally proven in clinical trials and many practical aspects and pitfalls should be taken into account when measuring energy expenditure in critically ill patients. Furthermore, the contribution of endogenously produced energy cannot be measured. Nevertheless, routine use of indirect calorimetry to aid personalized nutrition has strong potential to improve nutritional status and consequently, the long-term outcome of critically ill patients.

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Section: Indirect Calorimetrymentioning

confidence: 99%

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

2021

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“…Achieving and maintaining steady state during IC is recommended to improve measurement validity [7,35,43]. Steady state was monitored using the Quark RMR machinegenerated indicator, defined by the manufacturer [42] as a period when the average minute VO 2 and VCO 2 changes by less than 10% and the average RQ changes by less than 5%.…”

Section: Data Collection and Managementmentioning

confidence: 99%

“…Resting energy expenditure (REE) is a major and, for most individuals, the largest component of total energy expenditure [6]. Indirect open-circuit calorimetry (IC) is the most practical and widely employed method used to measure REE [7]. Many studies [8][9][10][11][12][13] suggest that lower REE may contribute to the higher prevalence of overweight and obesity in black African/African American individuals.…”

Section: Introductionmentioning

confidence: 99%

Resting Energy Expenditure and Related Factors in 6- to 9-Year-Old Southern African Children of Diverse Population Groups

et al. 2021

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Lower resting energy expenditure (REE) may partially explain the disproportionate prevalence of overweight/obesity among black African women. As no previous studies have investigated the REE of Southern African (South. Afr.) children, we aimed to determine, by sex and population group, the REE of 6- to 9-year-old urban school children. In a cross-sectional study with quota sampling, REE was measured with indirect calorimetry (IC). Confounders considered were: body composition (BC) (fat-free mass (FFM), FFM index, fat mass (FM), FM index), assessed using multifrequency bioelectrical impedance analysis, and physical activity (PA) measured with a pedometer. Multivariate regression was used to calculate REE adjusted for phenotypes (BC, z-scores of weight-for-age, height-for-age, body mass index-for-age) and PA. Sex and population differences in REE were determined with two-way ANOVA. Ninety-four healthy children (59.6% girls; 52.1% black) with similar socioeconomic status and PA opportunities participated. Despite BC variations, sex differences in REE were not significant (41 kcal/day; P = 0.375). The REE of black participants was lower than of white (146 kcal/day; P = 0.002). When adjusted for FFM and HFA z-score, the differences in REE declined but remained clinically meaningful at 91 kcal/day (P = 0.039) and 82 kcal/day (P = 0.108), respectively. We recommend the development of population-specific REE prediction equations for South. Afr. children.

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“…MClave et al described RQ limitations to truly reflect substrate oxidation, 4 but in the clinical condition described by Yu et al, with extremely low RQs 0.62 and 0.64 (the lowest from the RQ expected by fasting), one would wonder about indirect calorimetry device calibration errors or the presence of technical conditions that can alter indirect calorimetry results, 2 such as air leaks, hypoventilation, or the use of β‐blockers 7 …”

Section: Vco2 (Ml/min) Vo2 (Ml/min) Rqmentioning

confidence: 99%

Indirect Calorimetry in Critically Ill Patients With COVID‐19: More Questions Than Answers

Hurtado-Torres

2020

J Parenter Enteral Nutr

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Indirect calorimetry: The 6 main issues

Cited by 57 publications

References 46 publications

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

Resting Energy Expenditure and Related Factors in 6- to 9-Year-Old Southern African Children of Diverse Population Groups

Indirect Calorimetry in Critically Ill Patients With COVID‐19: More Questions Than Answers

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