Comparison of estimated energy requirements using predictive equations with total energy expenditure measured by the doubly labelled water method in acute spinal cord injury

Abstract

Study design Prospective, observational Objectives To evaluate agreement between a reference method (doubly labelled water, DLW) of total energy expenditure (TEE) and published equations for estimating energy requirements in acute spinal cord injury (SCI). Setting Victoria, Australia Methods Twenty participants (18 male) within 8 weeks of traumatic SCI completed DLW, anthropometric and dietary intake assessments. Energy requirements were predicted using Harris-Benedict, Schofield, Henry, Nelson, Buchholz and Chun equations, multiplied by a combined activity and stress factor of 1.3, and the ratio method (kJ/kg body weight). Fatfree mass (FFM) and fat mass (FM) were calculated from TBW-derived DLW and from bioelectrical impedance spectroscopy (BIS). Results Median time since injury was 41 days. Median TEE was 9.1 MJ. Fair agreement was found between TEE and predicted energy requirements for the Chun (r c = 0.39), the Harris-Benedict equation (r c = 0.30), the ratio method (r c = 0.23) and the Buchholz (r c = 0.31) and Nelson equations (r c = 0.35), which incorporate measures of FFM and/or FM. Other equations showed weak concordance with DLW. When two hypermetabolic patients were removed, agreement between TEE and predicted energy requirements using the Buchholz equation increased to substantial (r c = 0.72) and using the Nelson (r c = 0.53) and Chun equations (r c = 0.53) increased to moderate. The Buchholz equation had the smallest limits of agreement (−2.4-2.3 MJ/d). Conclusion The population-specific Buchholz equation that incorporates FFM, predicted from either BIS or DLW, demonstrated the best agreement in patients with acute SCI.

Stable isotopes: their use and safety in human nutrition studies

“…They are not radioactive, and can be administered in small amounts in their role in nutritional research. They have long been a safe tool for assessing various aspects of human nutrition, and continue to be so, often in potentially vulnerable groups including, for example, premature infants, children in both health and disease and individuals with severe injuries [2][3][4][5]. Whilst, as previously stated, radioactivity is not an issue with these two isotopes, it is right and proper that other aspects of the safety of these stable isotopes be considered and understood prior to their use in human studies.…”

Measured vs Predicted Energy Expenditure in Mechanically Ventilated Adults With Acute, Traumatic Spinal Cord Injuries

“…A recent study by Desneves and colleagues utilized the doubly labeled water technique to evaluate the validity of several predictive equations in a sample of 20 patients. Doubly labeled water studies were completed a median of 41 days (IQR, 28–48 days) post injury, and the authors determined that predictive equations that incorporated fat‐free mass into the calculations were more reliable than the others tested 25 . However, body composition testing is not currently completed during acute management of patients with acute, traumatic spinal cord injuries.…”

Energy expenditure and nutrient intake after spinal cord injury: a comprehensive review and practical recommendations

“…(90,94,95,98,102,103,130) In chronic SCI, TDEE is from 1332 to 2834 kcal/day (Table 4). (9,34,95,(99)(100)(101)122,131) TDEE is reduced in persons with chronic SCI by as much as 54% in persons with tetraplegia (131) and nearly 20% in individuals with paraplegia. (122) TDEE can be assessed by measuring average daily energy expenditure using direct, or whole body, calorimetry, doubly labeled water, and mechanical ventilation.…”

“…(132) Thus, making the technique mathematically complex and prone to miscalculation. Double labeled water is infrequently used (Desneves et al (95) and Tanhoffer et al (100,101) ) to measure TDEE after SCI. In 2012 and 2015, Tanhoffer et al (100,101) reported a mean TDEE of 2346 and 2406 kcal/day, respectively, in chronic SCI, while Desneves et al (95) reported 2354 kcal/day during the acute stage.…”