Energy Expenditure in Hospitalized Patients: Implications for Nutritional Support
Abstract
An understanding of energy expenditure in hospitalized patients is necessary to determine optimal energy supply in the care of individuals who require nutritional support. A review was conducted of 19 studies in which resting energy expenditure (REE) had been measured using indirect calorimetry and compared with estimated basal energy expenditure (BEE) from the Harris-Benedict equation. Studies of patients with burns, head injuries, and fever were excluded because REE is known to be increased in these conditions. The studies reported data on 1256 patients with the following diagnoses: postoperative (28%), trauma or sepsis (26%), cancer (18%), pulmonary disease (9%), cardiovascular disease (2%), miscellaneous (9%), and unspecified (6%). The average REE in the 19 studies was 113% of the BEE. The mean +/- SD REE/BEE ratio was higher in 11 studies in which the REE was measured during feeding than in 5 studies in which the measurement was made during fasting (117% +/- 3% vs 105% +/- 4%; P = .047). In those 11 studies, overfeeding may have contributed to higher REE values than otherwise would have been observed. Some evidence indicated that the REE/BEE ratio is higher in more severe illness, but results were inconsistent. Unfortunately, little information is available concerning total energy expenditure, which includes the contribution of physical activity. It appears that most patients can be fed adequately with energy equal to 100% to 120% of estimated BEE. Hypoenergetic feeding…
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Both published prediction equations and weight-based formulae provide valid estimates of energy requirements for groups of patients, but both are subject to significant bias and imprecision when applied to individuals.
“While both published prediction equations and weight-based formulae provide valid estimates of energy requirements for groups of patients, both methods are subject to significant bias and imprecision when applied to individuals [66,67].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [67]
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ESPEN guidelines on nutritional support for polymorbid internal medicine patients
Gomes, F., Schuetz, P., Bounoure, L., Austin, P., Ballesteros-Pomar, M., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., Poulia, K.-A., et al. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.06.025 · Cited by 363 · see citing works
ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“While both published prediction equations and weight-based formulae provide valid estimates of energy requirements for groups of patients, both methods are subject to signi fi cant bias and imprecision when applied to individuals [66,67].”
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Kao, C. C., Guntupalli, K. K., Bandi, V., & Jahoor, F. (2009) · Shock · doi:10.1097/shk.0b013e3181970f32 · Cited by 18 · see citing works
- Authors
- Miles, J. M.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Miles, John M.
- Venue
- Mayo Clinic Proceedings
- Publisher
- Elsevier BV
- Published
- 2006-06
- Volume
- 81
- Issue
- 6
- Pages
- 809-816
- ISSN
- 0025-6196 (ISSN-L)
- OpenAlex
- W2001279862
- Cited by
- 76
- References
- 0
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 2 · 2021: 4 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 6 · 2016: 5 · 2015: 2 · 2014: 4 · 2013: 8 · 2012: 5
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Mayo Clinic Proceedings (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL067933, HL67933)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- resting energy expenditure, hospitalized patients, nutritional support, Harris-Benedict equation, indirect calorimetry, energy supply, overfeeding, obesity, disease severity, postoperative patients, trauma (physical injury), cancer patients, lung disease
- MeSH terms
- Basal Metabolism, Calorimetry, Indirect, Energy Metabolism, Hospitalization, Humans, Patient Care Planning, Severity of Illness Index, Critical Illness, Nutritional Support
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