Innovations in energy expenditure assessment

Achamrah, N.; Oshima, Taku; Genton, Laurence

doi:10.1097/mco.0000000000000489

Cited by 11 publications

(7 citation statements)

References 28 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Predictive equations are available but not accurate. New techniques, including isotopic CO 2 breath measurement and wearable bracelets and waistbelts are being developed, but are not available yet [25].…”

Section: Discussionmentioning

confidence: 99%

Resting energy expenditure by indirect calorimetry versus the ventilator-VCO2 derived method in critically ill patients: The DREAM-VCO2 prospective comparative study

Koekkoek

Xiaochen

Dijk

et al. 2020

Clinical Nutrition ESPEN

View full text Add to dashboard Cite

Background & aims: Both overfeeding and underfeeding of intensive care unit (ICU) patients are associated with worse outcomes. Predictive equations of nutritional requirements, though easily implemented, are highly inaccurate. Ideally, the individual caloric target is based on the frequent assessment of energy expenditure (EE). Indirect calorimetry is considered the gold standard but is not always available. EE estimated by ventilator-derived carbon dioxide consumption (EEVCO 2) has been proposed as an alternative to indirect calorimetry, but there is limited evidence to support the use of this method. Methods: We prospectively studied a cohort of adult critically ill patients requiring mechanical ventilation and artificial nutrition. We aimed to compare the performance of the EEVCO 2 with the EE measured by indirect calorimetry through the calculation of bias and precision (accuracy), agreement, reliability and 10% accuracy rates. The effect of including the food quotient (nutrition intake derived respiratory quotient) in contrast to a fixed respiratory quotient (0.86), into the EEVCO 2 formula was also evaluated. Results: In 31 mechanically ventilated patients, a total of 414 paired measurements were obtained. The mean estimated EEVCO 2 was 2134 kcal/24 h, and the mean estimated EE by indirect calorimetry was 1623 kcal/24 h, depicting a significant bias of 511 kcal (95% CI 467e560, p < 0.001). The precision of EEVCO 2 was low (lower and upper limit of agreement À63.1 kcal and 1087. o kcal), the reliability was good (intraclass correlation coefficient 0.613; 95% CI 0.550e0.669, p < 0.001) and the 10% accuracy rate was 7.0%. The food quotient was not significantly different from the respiratory quotient (0.870 vs. 0.878), with a small bias of 0.007 (95% CI 0.000e0.015, p ¼ 0.54), low precision (lower and upper limit of agreement À0.16 and 0.13), poor reliability (intraclass correlation coefficient 0.148; 95% CI 0.053e0.240, p ¼ 0.001) and a 10% accuracy rate of 77.5%. Estimated mean EEVCO 2 , including the food quotient, was 2120 kcal/24 h, with a significant bias of 496 kcal (95% CI 451e542; p < 0.001) and low precision (lower and upper limit of agreement À157.6 kcal and 1170.3 kcal). The reliability with EE estimated by indirect calorimetry was good (intraclass correlation coefficient 0.610, 95% CI 0.550e0.661, p < 0.001), and the 10% accuracy rate was 9.2%. Conclusions: EEVCO 2 , compared with indirect calorimetry, overestimates actual energy expenditure. Although the reliability is acceptable, bias is significant, and the precision and accuracy rates are unacceptably low when the VCO 2 method is used. Including the food quotient into the EEVCO 2 equation does not improve its performance. Predictive equations, although inaccurate, may even predict energy expenditure better compared with the VCO 2-method. Indirect calorimetry remains the gold standard method.

show abstract

Section: Discussionmentioning

confidence: 99%

Resting energy expenditure by indirect calorimetry versus the ventilator-VCO2 derived method in critically ill patients: The DREAM-VCO2 prospective comparative study

Koekkoek

Xiaochen

Dijk

et al. 2020

Clinical Nutrition ESPEN

View full text Add to dashboard Cite

show abstract

“…Kagan et al performed a retrospective observational study comparing IC-REE and VCO2-REE, finding that the level of agreement between the two REE measurements was highest when using an RQ value of 0.89 [33]. RQ is influenced by many factors, such as ventilation and acid-base balance, which are both highly unstable in critically ill patients [34], which is one of the reasons why this method is so controversial; however, although its drawbacks must be acknowledged, at this point it seems to be the best alternative to indirect calorimetry regarding energy expenditure estimation.…”

Section: The Use Of Indirect Calorimetrymentioning

confidence: 99%

“…As a result, hyperglycemia became a serious concern, with multiple reports of its detrimental effects [47][48][49]. The development of safer and less inflammatory lipid emulsions decreased the carbohydrate contents of formulas and therefore the prevalence of hyperglycemia; however, hyperglycemia remains the most common complication of PN [34]. IV dextrose causes a more pronounced increase in blood glucose levels compared to the same amount received enterically due to IV dextrose bypassing the enteroinsular axis [34].…”

Section: Glucose Controlmentioning

confidence: 99%

“…The development of safer and less inflammatory lipid emulsions decreased the carbohydrate contents of formulas and therefore the prevalence of hyperglycemia; however, hyperglycemia remains the most common complication of PN [34]. IV dextrose causes a more pronounced increase in blood glucose levels compared to the same amount received enterically due to IV dextrose bypassing the enteroinsular axis [34]. Van Der Berghe et al concluded in an RCT that tight glycemic control of below 110 mg/dL reduced mortality and morbidity in critically ill surgical patients [50].…”

Section: Glucose Controlmentioning

confidence: 99%

See 1 more Smart Citation

Advances in Medical Nutrition Therapy: Parenteral Nutrition

Itzhaki

Singer

2020

Nutrients

View full text Add to dashboard Cite

Parenteral nutrition has evolved tremendously, with parenteral formulas now safer and more accessible than ever. "All-in-one" admixtures are now available, which simplify parenteral nutrition usage and decrease line infection rates alongside other methods of infectious control. Recently published data on the benefits of parenteral nutrition versus enteral nutrition together with the widespread use of indirect calorimetry solve many safety issues that have emerged over the years. All these advances, alongside a better understanding of glycemic control and lipid and protein formulation improvements, make parenteral nutrition a safe alternative to enteral nutrition.

show abstract

“…Basal metabolic rate, termed also resting energy expenditure (REE), is the rate at which the body burns calories at rest (Achamrah, Oshima, & Genton, 2018; Oshima et al, 2017). REE represents 60% of the total 24‐hr energy expenditure (Oshima et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Resting energy expenditure in acutely ill and stabilized patients with anorexia nervosa and bulimia nervosa

Kochavi

Mendelowitsch

Enoch‐Levy

et al. 2020

Intl J Eating Disorders

View full text Add to dashboard Cite

Objective Determining resting energy expenditure (REE) may be important in the nutritional assessment of adolescents with eating disorders (EDs). Calculated equations assessing REE, developed according to data from healthy people, may under‐ or overestimate REE in EDs. We have sought to compare the REE measured in clinical settings to that calculated using equations in actively ill adolescents with anorexia nervosa (AN) and bulimia nervosa (BN), and following stabilization of weight and disordered eating. Methods Thirty‐five female adolescents with AN and 25 with BN were assessed at admission to inpatient treatment and at discharge. REE was measured using indirect calorimetry (DELTATRAC Metabolic Monitor). Expected REE was calculated using the Harris–Benedict equation. Results An overestimation of expected versus measured REE was found for both patients with AN and BN, both at admission and discharge. Second, the differences between expected and measured REE were significantly less robust in BN versus AN. Third, REE before renourishing was lower in inpatients with AN versus BN. Fourth, the REE of patients with AN (both measured and expected) increased from admission to discharge, to a greater extent than expected solely from the increase in weight. The difference between admission and discharge expected and measured REE was significant also in patients with BN. Discussion Our findings suggest that predicted and measured REE are different in both AN and BN, and that both expected and measured REE are not useful in the planning of renourishing programs in patients with AN.

show abstract

Innovations in energy expenditure assessment

Abstract: Some new innovative methods are demonstrating promises in energy expenditure assessment, but still need to be validated. There is an ongoing need for easy-to-use, accurate and affordable indirect calorimeter for daily use in in-patients and out-patients.

Cited by 11 publications

References 28 publications

Resting energy expenditure by indirect calorimetry versus the ventilator-VCO2 derived method in critically ill patients: The DREAM-VCO2 prospective comparative study

Resting energy expenditure by indirect calorimetry versus the ventilator-VCO2 derived method in critically ill patients: The DREAM-VCO2 prospective comparative study

Advances in Medical Nutrition Therapy: Parenteral Nutrition

Resting energy expenditure in acutely ill and stabilized patients with anorexia nervosa and bulimia nervosa

Contact Info

Product

Resources

About