Weekly Measurements Accurately Represent Trends in Resting Energy Expenditure in Children Undergoing Hematopoietic Stem Cell Transplantation

Abstract

Background Resting energy expenditure (REE) measurements are optimal for accurate assessment of energy requirements and precise provision of parenteral nutrients. We previously observed significant reduction in REE during a 4-week period in children undergoing hematopoietic stem cell transplantation (HSCT). The goal of this study was to determine if weekly REE measurements could accurately represent changes in REE in the peritransplant period compared with a more frequent standard of daily measurements. Methods Data are presented from a previously described cohort of 37 children undergoing HSCT. We performed weekly indirect calorimetry on 25 patients; of those 25, we performed daily measurements on a convenience sample of 5 children. The time course of REE was analyzed in each sample by repeated measures regression. Results The REE trend of the 20 weekly participants was similar to that of the 5 daily participants, reaching about 80% of predicted REE at 4 weeks posttransplant, with an average decline of 3.4% per week during 4 weeks. Conclusion The results suggest that weekly REE measurements accurately characterize REE changes 4 weeks after HSCT compared with daily measurements. Characterization of these trends using weekly measurements may help guide clinical and nutrition care of these patients.

Nutrition management of pediatric patients undergoing hematopoietic stem cell transplantation: Guidelines, gaps, and research

“…These fluctuations may be attributed to type of conditioning regimen (total body irradiation, chemotherapy), fever, mucositis, engraftment, posttransplant complications such as GVHD, and lean muscle mass. 16,[36][37][38] The use of indirect calorimetry for estimation of energy needs is considered the criterion standard and may be warranted in this population. This recommendation is made in light of the fluctuation of energy needs over time, inaccuracy in energy equations, and changes in lean muscle mass and fluid shifts that occur.…”

“…Pediatric patients (0–18 years of age) undergoing HSCT therapy may experience fluctuations in energy requirements throughout the continuum of care. These fluctuations may be attributed to type of conditioning regimen (total body irradiation, chemotherapy), fever, mucositis, engraftment, posttransplant complications such as GVHD, and lean muscle mass 16,36–38 . The use of indirect calorimetry for estimation of energy needs is considered the criterion standard and may be warranted in this population.…”

Nutritional Support

“…Most studies investigating energy expenditure by indirect calorimetry have been performed in small paediatric populations. Validity of the data for adults therefore is limited, and results are controversial (Sharma et al 2012;Duro et al 2008).…”

Medical Nutritional Therapy in Hematopoietic Stem Cell Transplantation (HSCT)

“…19 Duro et al 20 observed significant reduction in resting energy expenditure (REE) during a 4-week period in children undergoing HSCT. Although the amount of energy expended by a patient with HSCT may vary according to whether it is autologous or allogeneic, there is agreement as to the energy requirements of the transplant recipient, which may increase up to 130-150% of the estimated basal energy expenditure, which corresponds to 30-50 kcal/kg of body weight per day.…”