Resting energy expenditure measured longitudinally following hip fracture compared to predictive equations: is an injury adjustment required?

Abstract

The present study measuring resting energy expenditure (REE; kJ/d) longitudinally using indirect calorimetry in six elderly women aged $70 years following surgery for hip fracture, describes changes over time (days 10, 42 and 84 post-injury) and compares measured values to those calculated from routinely applied predictive equations. REE was compared to REE predicted using the Harris Benedict and Schofield equations, with and without accounting for the theoretical increase in energy expenditure of 35 % secondary to physiological stress of injury and surgery. Mean (95 % CI) measured REE (kJ/d) was 4704 (4354, 5054), 4090 (3719, 4461) and 4145 (3908, 4382) for days 10, 42 and 84, respectively. A time effect was observed for measured REE, P¼0·003. Without adjusting for stress the mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Harris Benedict equation were 1 (29, 12), 10 (2, 18) and 9 (1, 17) for days 10, 42 and 84, respectively. The mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Schofield equation without adjusting for stress were 8 (23, 19), 16 (6, 26) and 16 (10, 22) for days 10, 42 and 84, respectively. After adjusting for stress, REE predicted from the Harris Benedict or Schofield equations overestimated measured REE by between 38 and 69 %. Energy expenditure following fracture is poorly understood. Our data suggest REE was relatively elevated early in recovery but declined during the first 6 weeks. Using the Harris Benedict or Schofield equations adjusted for stress may lead to overestimation of REE in the clinical setting. Further work is required to evaluate total energy expenditure before recommendations can be made to alter current practice for calculating theoretical total energy requirements of hip fracture patients.

Low postoperative dietary intake is associated with worse functional course in geriatric patients up to 6 months after hip fracture

“…In view of the fact that the three main meals provided daily by hospital catering contained on average 8400 kJ (2000 kcal) and 80 g protein/d, mean daily energy and protein intake per patient from main meals in the present study can very roughly be estimated as < 2100 kJ and < 20 g protein/d when DI ≤ 25 %, and as < 4200 kJ and < 40 g protein/d when DI >25–50 %. Even if an additional daily intake from snacks and supplements of about 30 % is assumed, this would only result in approximately < 2700 kJ and < 26 g protein/d, and about < 5400 kJ and < 52 g protein/d, respectively, which would still be far below most patients' requirements ( 48 ) .…”

Vulnerable patients with a fractured neck of femur: nutritional status and support in hospital

“…In addition, bed rest impacts on energy expenditure and, thus energy requirements. (Miller et al. , 2005b) reported that resting metabolic rate was lower in the late post‐operative period (day 10–42) compared with the early postoperative period in patients recovering from surgery for a fractured NOF.…”

Padronização do gasto metabólico de repouso e proposta de nova equação para uma população feminina brasileira

“…Entretanto, há estudos que sugerem que as fórmu-las podem levar a super ou subestimação do GMR, isso porque a população estudada nem sempre corresponde à população utilizada para elaboração das fórmulas (8)(9)(10)(11)(12). No Brasil, HB é a equação mais utilizada, entretanto estudos indicam que existe uma superestimação em adultos de 18 a 59 anos, especialmente em mulheres (13,14).…”