Assessment of resting energy expenditure in patients with cirrhosis

Abstract

BACKGROUND Malnutrition affects 20% to 50% of patients with cirrhosis. It may be associated with serious complications and has a direct impact on prognosis. Resting energy expenditure (REE) is an important parameter to guide the optimization of therapy and recovery of nutritional status in patients with cirrhosis. However, the REE of patients with cirrhosis is still unclear, casting doubt upon the optimal nutritional management approach. AIM To identify the best method that predicts the REE of cirrhotic patients, using indirect calorimetry (IC) as the gold standard. METHODS An observational study was performed on 90 patients with cirrhosis. REE was assessed by IC, bioelectrical impedance analysis (BIA), and predictive formulas, which were compared using Bland-Altman plots and the Student’s t -test. RESULTS REE values measured by IC (1607.72 ± 257.4 kcal) differed significantly from those determined by all other methods (BIA: 1790.48 ± 352.1 kcal; Harris & Benedict equation: 2373.54 ± 254.9 kcal; IOM equation: 1648.95 ± 185.6 kcal; Cunningham equation: 1764.29 ± 246.2 kcal), except the Food and Agriculture Organization of the United Nations, World Health Organization, and United Nations University (FAO/WHO/UNU) (1616.07 ± 214.6 kcal) and McArdle (1611.30 ± 241.8 kcal) equations. We found no significant association when comparing IC and 24-h dietary recall among different Child-Pugh classes of cirrhosis. CONCLUSION The IOM and FAO/WHO/UNU equations have the best agreement with the CI. These results indicate a possibility of different tools for the clinical practice on cirrhotic patients.

<i>FTO</i> genotypes (rs9939609 T&gt;A) are Associated with Increased Added Sugar Intake in Healthy Young Adults

“…The breakfast was prepared at the “CUCSINE, Laboratorio de Gestión de Servicios de Alimentos, Centro de Universitario de Ciencias de la Salud, Universidad de Guadalajara,” and consisted of 526 kilocalories of which 43% were carbohydrates, 36% were fat, and 21% were protein. To know how much the breakfast contributed to the energy requirement of the participants, the total energy requirements was calculated as the sum of resting metabolic rate using Cunningham formula [31] + thermogenic food effect + factor of physical activity.…”

Evaluation and Management of Nutritional Consequences of Chronic Liver Diseases

“…The total energy expenditure consists of a combination of the resting metabolic rate, also called the "resting energy expenditure" (REE), the physical activity expenditure, and the diet-induced thermogenesis. The REE represents the total number of calories burned when the body is completely at rest [39] and reflects the energy required to maintain physiological processes, representing approximately 60-70% of the total daily energy requirement. The REE is raised to the tune of 120% of the expected value in more than onethird of cirrhotic patients as a result of the hypercatabolic state [40].…”

Screening and assessment of malnutrition in patients with liver cirrhosis

“…There is an increase in pro-inflammatory flora such as Enterobacteriaceae, a phenomenon that usually leads to inflammation in cirrhotic patients, accompanied with increased protein metabolism and loss of muscle mass ( 12 ). Resting energy expenditure accounts for 60–70% of total energy expenditure in healthy individuals ( 13 ) and is often increased in patients with cirrhosis due to hypermetabolism, inflammatory response, and immunosuppression ( 14 ). Patients with cirrhosis tend to have increased protein metabolism and decreased synthesis in close relation to malnutrition ( 15 ).…”