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Cited by 58Clinical Nutrition and GastroenterologyBody Composition Measurement TechniquesNutrition and Health in Aging

An evaluation of resting energy expenditure in hospitalized, severely underweight patients

Ahmad, Arif, Duerksen, Donald R, Munroe, Scott, Bistrian, Bruce R·1999·Nutrition
DOI 10.1016/s0899-9007(99)00068-4
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Abstract

A prospective trial was conducted with 14 hospitalized patients who were severely underweight with a mean weight of 40.9+/-5.1 kg and 70.7+/-7.8% of ideal body weight, to compare estimates of resting energy expenditure (REE) with measured values. The 9 women and 3 men, whose mean age was 66.5+/-13.9 y, underwent nutritional assessment and measurement of their REE by indirect calorimetry using the Sensormedics Deltatrac MBM100 indirect calorimeter. Their REE was also estimated by the Harris-Benedict formula (mean 1032+/-66 kcal/d) as well as a previously established empirical formula where REE = 25 x body weight in kg (mean 1023+/-129 kcal/d). Results by both estimates were significantly lower than the measured resting energy expenditure (MREE) in this group of patients (P<0.0001). The percentage difference between MREE and estimated REE by the Harris-Benedict formula was 18.4+/-9.4% and 20.9+/-7.5% by the empirical formula. The MREE exceeded the estimated REE in each individual. The correlation between MREE and body weight (r2 = 0.558, r = 0.005) was better than that between MREE and estimated REE by Harris-Benedict formula (r2 = 0.275, P = 0.08) suggesting that weight was the principal determinant rather than the other components (height, age, sex) of the Harris-Benedict formula. Our data shows that commonly employed formulae routinely underestimate the energy needs of severely underweight patients below 50 kg in body weight. The Harris-Benedict equation had limited predictive value for the individual, explaining approximately 25% of the variance in energy expenditure. Given the particular importance of matching energy intake to needs in this group of patients with limited reserves, many of whom are critically ill, we suggest an empirical equation using 30-32 kcal/kg be used to estimate the energy requirements of severely underweight patients when direct measurements are unavailable or clinically less imperative.

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Crossref · 10.1016/s0899-9007(99)00068-4

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  • The study's results should be interpreted with caution because the sample size was very small and patients received continuous EN or PN during IC, so measured energy expenditure included diet-induced thermogenesis.

    “These results should be interpreted with caution since the sample size was very small.Furthermore, patients received continuous EN or PN during IC and thus measured energy expenditure included not only REE but also diet-induced thermogenesis.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [73]

  • In a study of 14 severely underweight hospitalized patients, mean REE by IC was 1300 ± 160 kcal/day, equating to 31.4 kcal/kg body weight.

    “In this study mean REE by IC was 1300 ± 160 kcal/day equating to 31.4 kcal/kg body weight.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [73]

  • In the absence of IC, REE for severely underweight patients can be estimated at 30 kcal/kg actual body weight.

    “In the absence of IC, REE for severely underweight patients can be estimated at 30 kcal/kg actual body weight.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [73]

  • REE predictive equations are frequently affected by disease characteristics such as respiratory failure, body temperature, severe trauma, burns, especially in obese or low-weight critically ill populations.

    “Firstly, compared with healthy individuals, REE predictive equations are frequently affected by disease characteristics such as respiratory failure, body temperature, severe trauma, burns, especially in obese or low-weight critically ill populations [8, 25].”

    From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [8]

  • The TICACOS study found an improvement in 60-day survival in the per-protocol study in the IC group (57.9% vs. 48.1%, P = 0.023).

    “The tight calorie control study (TICACOS) compared IC-guided nutrition therapy to a single weight-based measurement and found an improvement in 60-day survival in the per-protocol study in the IC group (57.9% vs. 48.1%, P = 0.023) [8].”

    From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [8]

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Authors
Ahmad, A., Duerksen, D. R., Munroe, S., & Bistrian, B. R.
Affiliations
Beth Israel Deaconess Medical Center (US)
Corresponding author
Bistrian, Bruce R
ORCID
Venue
Nutrition
Publisher
Elsevier BV
Published
1999-05
Volume
15
Issue
5
Pages
384-388
ISSN
0899-9007 (ISSN-L)
DOI
10.1016/s0899-9007(99)00068-4
OpenAlex
W2040201371
Cited by
58
References
30
Citations by year
2026: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 7 · 2020: 2 · 2018: 1 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 3 · 2012: 4
FWCI
0.00
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Nutrition (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
resting energy expenditure, Harris-Benedict equation, energy demand estimation, indirect calorimetry, hospitalized patients, critically ill patients
MeSH terms
Adult, Aged, Aged, 80 and over, Anthropometry, Basal Metabolism, Calorimetry, Indirect, Energy Metabolism, Female, Hospitalization, Humans, Male, Middle Aged, Protein-Energy Malnutrition, Thinness, Weight Loss

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