A new method for the estimation of the components of energy expenditure in patients with major trauma

Franch-Arcas, Guzmán; Plank, Lindsay D.; Monk, David; Gupta, Ramesh C.; Ka, Maher; Gillanders, Lyn; Hill, Graham L.

doi:10.1152/ajpendo.1994.267.6.e1002

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…The present results, based on a number of published studies carried out in our facility (Franch-Arcas et al 1994;Monk et al 1996;Plank et al 1998) in which integrated ∆TBF have been measured over the first or second week after the onset of critical illness, confirm that fat is not an obligatory energy source in critically-ill patients. An earlier study of patients with sepsis from our laboratory (Streat et al 1987) suggested, on the basis of a less direct measurement of TBF, that aggressive nutritional support could prevent lipolysis.…”

Section: Resultssupporting

confidence: 80%

“…TBF and bone mineral content were measured by dualenergy X-ray absorptiometry, TBP by in vivo neutron activation analysis and total body water by 3 H 2 O dilution. Total body mineral was obtained as the sum of bone mineral content and an estimated non-bone mineral content, while TBG was derived according to the following equation (Franch-Arcas et al 1994):…”

Section: Methodsmentioning

confidence: 99%

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Energy balance in critical illness

Plank

Hill

2003

Proc. Nutr. Soc.

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Abbreviations: ICU, intensive care unit; TBF, total body fat; TBG, total body glycogen; TBP, total body protein; TEE, total energy expenditure; ∆TBF, ∆T-BG, ∆TBP, changes in TBF, TBG and TBP respectively over 5 d periods. Energy balance is the difference between energy consumed and total energy expended. Over a given period of time it expresses how much the body stores of fat, carbohydrate and protein will change. For the critically-ill patient, who characteristically exhibits raised energy expenditure and proteolysis of skeletal muscle, energy balance information is valuable because underfeeding or overfeeding may compromise recovery. However, there are formidable difficulties in measuring energy balance in these patients. While energy intake can be accurately recorded in the intensive care setting, the measurement of total energy expenditure is problematic. Widely used approaches, such as direct calorimetry or doubly-labelled water, are not applicable to the critically ill patient. Energy balance was determined over periods of 5-10 d in patients in intensive care by measuring changes in the fat, protein and carbohydrate stores of the body. Changes in total body fat were positively correlated with energy balance over the 5 d study periods in patients with severe sepsis (n 24, r 0 · 56, P = 0 · 004) or major trauma (n 24, r 0 · 70, P < 0 · 0001). Fat oxidation occurred in patients whose energy intake was insufficient to achieve energy balance. Changes in body protein were independent of energy balance. These results are consistent with those of other researchers who have estimated total energy requirements from measurements of O 2 consumption and CO 2 production. In critically-ill patients achievement of positive non-protein energy balance or total energy balance does not prevent negative N balance. Nutritional therapy for these patients may in the future focus on glycaemic control with insulin and specialised supplements rather than on energy balance per se. Critical illness: Energy balance: Nutritional supportICU, intensive care unit; TBF, total body fat; TBG, total body glycogen; TBP, total body protein; TEE, total energy expenditure; ∆TBF, ∆TBG, ∆TBP, changes in TBF, TBG and TBP respectively over 5 d periods.Energy balance is the difference between energy consumed and total energy expended. For critically-ill patients in the intensive care unit (ICU) there are formidable technical difficulties in measuring energy balance. While energy intakes can be accurately recorded in this setting the measurement of total energy expenditure (TEE) is problematic. Energy balance over a given period of time expresses how much the body stores of fat, carbohydrate and protein will change. Energy balance was determined over the first 2 weeks of intensive care in critically-ill patients by measuring changes in the fat, protein and carbohydrate stores of the body. These measurements were possible because of advances in body composition technology and the close proximity to the ICU of our facility, which is purposely designed to ...

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Section: Resultssupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Energy balance in critical illness

Plank

Hill

2003

Proc. Nutr. Soc.

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“…A total of 1653 articles were excluded for various reasons, leaving 15 articles for examination. Four studies using single‐frequency bioimpedance analysis and 5 studies with duplicate data were excluded, leaving 6 studies meeting the inclusion criteria . There were no discrepancies between researchers in terms of eligibility of the studies, data extraction, or study quality.…”

Section: Resultsmentioning

confidence: 99%

“…To compare the nutrition provision in each study against these guidelines, energy and protein delivery were represented as mean kcal and grams of protein delivered/kg per day during the study period. Weight was taken as either the estimated mean participant weight reported in the study (actual or obesity‐adjusted body weight) or the measured weight on day 10, which has been reported to be the closest to pre‐illness weight …”

Section: Methodsmentioning

confidence: 99%

Association of Energy and Protein Delivery on Skeletal Muscle Mass Changes in Critically Ill Adults: A Systematic Review

Lambell

King

Forsyth

et al. 2018

J Parenter Enteral Nutr

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Critically ill patients experience significant and rapid loss of skeletal muscle mass, which has been associated with negative clinical outcomes. The aetiology of muscle wasting is multifactorial and nutrition delivery may play a role. A systematic literature review was conducted to examine the association of energy and/or protein provision on changes in skeletal muscle mass in critically ill patients. Key databases were searched up until March 2016 to identify studies that measured skeletal muscle mass and/or total body protein (TBP) at 2 or more time points during acute critical illness (up to 2 weeks after an intensive care unit [ICU] stay). Studies were included if there was documentation of participant energy balance or mean energy delivered to participants during the time period between body composition measurements. Six studies met inclusion criteria. A variety of methods were used to assess skeletal muscle mass or TBP. Participants in included studies experienced differing levels of muscle loss (0%-22.5%) during the first 2 weeks of ICU admission. No association between energy and protein delivery and changes in skeletal muscle mass were observed. This review highlights that there is currently limited high-quality evidence to clearly define the association between energy and/or protein delivery and skeletal muscle mass changes in acute critical illness. Future studies in this area should be adequately powered, account for all potential confounding factors to changes in skeletal muscle mass, and detail all sources and quantities of energy and protein delivered to participants.

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“…ECW/ICW reflects body hydration and FFM, and BCM reflects metabolic status (11, 12). Several studies have demonstrated that critically ill patients have considerable variation in energy expenditure patterns (13–15). Within the ICU setting, hypermetabolism induced by disease and medical intervention results in accelerated loss of protein and fat.…”

Section: Discussionmentioning

confidence: 99%