Comparison of predictive equations for resting energy expenditure among patients with schizophrenia in Japan

Abstract

BackgroundRecently, a relationship between obesity and schizophrenia has been reported. The prediction of resting energy expenditure (REE) is important to determine the energy expenditure of patients with schizophrenia. However, there is a lack of research concerning the most accurate REE predictive equations among Asian patients with schizophrenia. The purpose of the study reported here was to compare the validity of four REE equations for patients with schizophrenia taking antipsychotics.MethodsFor this cross-sectional study, we recruited patients (n=110) who had a Diagnostic and Statistical Manual of Mental Disorders, fourth edition, diagnosis of schizophrenia and were admitted to four psychiatric hospitals. The mean (± standard deviation) age of these patients was 45.9±13.2 years. Anthropometric measurements (of height, weight, body mass index) were taken at the beginning of the study. REE was measured using indirect calorimetry. Comparisons between the measured and estimated REEs from the four equations (Harris–Benedict, Mifflin–St Jeor, Food and Agriculture Organization/World Health Organization/United Nations University, and Schofield) were performed using simple linear regression analysis and Bland–Altman analysis.ResultsSignificant trends were found between the measured and predicted REEs for all four equations (P<0.001), with the Harris–Benedict equation demonstrating the strongest correlation in both men and women (r=0.617, P<0.001). In all participants, Bland–Altman analysis revealed that the Harris–Benedict and Mifflin–St Jeor equations did not show a significant bias in the prediction of REE, however, a significant overestimation error was shown for the Food and Agriculture Organization/World Health Organization/United Nations University and Schofield equations.ConclusionWhen estimating REE in patients with schizophrenia taking antipsychotics, the Harris–Benedict equation appears to be the most appropriate for clinical use.

Indirect Calorimetry to Measure Metabolic Rate and Energy Expenditure in Psychiatric Populations: A Systematic Review

“…The titles and abstracts of these 2947 studies were screened and 2912 irrelevant studies were excluded, leaving 35 studies for which the full texts were assessed for eligibility. Of the remaining 35 studies, 16 were excluded, and thus, the final synthesis and review included 19 studies ( Figure 1 ) [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

“…Predictive equations for metabolic rate/EE were not as accurate in psychiatric patients as they were in healthy controls [ 32 , 36 , 38 , 39 , 40 ]. Four studies demonstrated commonly used predictive REE equations to systematically overestimate REE in psychiatric patients [ 36 , 38 , 39 , 40 ]. Between studies, there were discordant results in the suitability of specific predictive equations at estimating REE.…”

Nutrition problems in a severe burn patient with schizophrenia: a case report

“…A higher prevalence of underweight was found in a cohort of 23.116 adults with schizophrenia than in the general population in Japan (13.8% vs 7.9%). In Asia, it has been reported that the prevalence of underweight and undernutrition in chronically hospitalized patients with schizophrenia is substantially higher than that in the general population [ 2 ]. Schizophrenia may increase morbidity due to self-destructive behavior, changes in nutrition intake, sleep disturbance, and medications that influence the immune system.…”

“…Various equations have been developed to estimate nutrition and calorie requirements for burn patients. Sugawara and colleagues suggested that the Harris-Benedict equation is the most appropriate to estimate resting energy expenditure (REE) and predicted energy expenditure (PEE) in schizophrenic patients with antipsychotic medications ( Table 1 ) [ 2 , 4 ]. However, this formula could only act as a guide.…”

“…On the other hand, nutrition intake often fell significantly. The presence of psychiatric comorbidity may worsen the nutrition status due to adverse medication effects, negative affective symptoms, and reduced nutrition intake [ 2 ]. Surgery, as one of the treatment options for burns, could also lead to tissue inflammation that corresponds with the extent of the surgical trauma.…”