Measured and Predicted Resting Energy Expenditure in Malnourished Older Hospitalized Patients: A Cross-Sectional and Longitudinal Comparison

Abstract

A number of equations have been proposed to predict resting energy expenditure (REE). The role of nutritional status in the accuracy and validity of the REE predicted in older patients has been paid less attention. We aimed to compare REE measured by indirect calorimetry (IC) and REE predicted by the Harris–Benedict formula in malnourished older hospitalized patients. Twenty-three malnourished older patients (age range 67–93 years, 65% women) participated in this prospective longitudinal observational study. Malnutrition was defined as Mini Nutritional Assessment Long Form (MNA-SF) score of less than 17. REE was measured (REEmeasured) and predicted (REEpredicted) on admission and at discharge. REEpredicted within ±10% of the REEmeasured was considered as accuracy. Nutritional support was provided to all malnourished patients during hospitalization. All patients were malnourished with a median MNA-LF score of 14. REEmeasured and REEpredicted increased significantly during 2-week nutritional therapy (+212.6 kcal and +19.5 kcal, respectively). Mean REEpredicted (1190.4 kcal) was significantly higher than REEmeasured (967.5 kcal) on admission (p < 0.001). This difference disappeared at discharge (p = 0.713). The average REEpredicted exceeded the REEmeasured on admission and at discharge by 29% and 11%, respectively. The magnitude of difference between REEmeasured and REEpredicted increased along with the degree of malnutrition (r = 0.42, p = 0.042) as deviations ranged from −582 to +310 kcal/day in severe to mildly malnourished patients, respectively. REEpredicted by the Harris–Benedict formula is not accurate in malnourished older hospitalized patients. REE measured by IC is considered precise, but it may not represent the true energy requirements to recover from malnutrition. Therefore, the effect of malnutrition on measured REE must be taken into account when estimating energy needs in these patients.

Severity of Inflammation Is Associated with Food Intake in Hospitalized Geriatric Patients—A Merged Data Analysis

“…This energy imbalance, which is mainly characterized by insufficient energy intake, is a common occurrence in older individuals [ 5 ]. However, the mechanisms underlying this imbalance are multifaceted and include physiological changes such as a decrease in basal metabolic rate and impaired absorption of nutrients due to age-related changes in the gastrointestinal tract, age-related alterations in hormone levels, and acute or chronic diseases (e.g., infections, surgery, cardiovascular disease, and diabetes) [ 2 , 6 , 7 , 8 ]. Additional contributing factors encompass poor dental health, difficulties in chewing and swallowing, pharmacological treatment side effects, cognitive impairments, and social factors such as isolation, loneliness, and depression, which can negatively affect appetite and energy balance, accelerating a decline in food consumption among this patient group [ 2 ].…”

Hospital nutrition: dietary intake characteristics among adults with NCDs (Algeria, 2020)

“…This result is consistent when comparing the predicted energy and protein values with the DRV. Although the DRV are used among healthy people, it may help to emphasize a lack of energy or nutrients in ill people with increased energy needs; despite any overestimation or underestimation by the Harris-Benedict equation 25,30 .…”