Overfeeding Macronutrients to Critically Ill Adults

Klein, Catherine J.; Stanek, Gena S; Wiles, Charles E.

doi:10.1016/s0002-8223(98)00179-5

Cited by 315 publications

(198 citation statements)

References 85 publications

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“…This study indicates that the automatic application of an injury factor for patients with pancreatic cancer is not appropriate, as only 20% of measurements were greater than 110% of predicted REE from the Harris-Benedict equations. Such gross overestimation of energy requirements could lead to negative complications associated with overfeeding [11]. A wide range of metabolism from hypometabolic to hypermetabolic has been observed in cancer patients [14,28,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…Underfeeding and possible further weight loss in malnourished patients can result in an increase in complications and increased length of stay [10]. Overfeeding is also associated with complications such as hyperglycaemia, hyperlipidemia, hepatic dysfunction and respiratory distress [11]. Studies comparing mean measured REE and predicted REE by Harris-Benedict equations [12] in patients with pancreatic cancer have shown inconsistent results [13,14,15].…”

Section: Introductionmentioning

confidence: 99%

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The agreement between measured and predicted resting energy expenditure in patients with pancreatic cancer — A pilot study

Bauer

Reeves²,

Capra³

2003

Clinical Nutrition

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Objective To compare measured resting energy expenditure to resting energy expenditure predicted from eight published prediction equations in a sample of patients with pancreatic cancer.Design Cross-sectional study.Setting Ambulatory patients of a tertiary private hospital.Participants Eight patients with pancreatic cancer (5 males, 3 females; age: 62.0±5.2 years; BMI: 24.4±3.2 kg/m 2 ; weight loss: 12.1±6.0%; mean±SD). MethodsResting energy expenditure was measured using indirect calorimetry and predicted from eight published prediction methods (Harris-Benedict with no injury factor, Harris-Benedict with 1.3 injury factor, Schofield, Owen, Mifflin, Cunningham, and Wang equations and the 20 kcal/kg ratio). Body composition was assessed by deuterium oxide dilution technique. Statistical analysis was performed by using the method of Bland and Altman, and the Student's t-test. ResultsThe Harris-Benedict equations with an injury factor of 1.3 resulted in a significantly higher mean predicted resting energy expenditure compared to measured resting energy expenditure, while there was no significant difference between mean measured and predicted resting energy expenditure and the other 7 methods. At an individual level, the limits of agreement are wide for all equations. The best combination of low bias and narrowest limits of agreement was observed in the prediction of resting energy expenditure from the Wang equation (based on fat free mass) and the HarrisBenedict equation (based on weight and height). ConclusionAt a group level, there is agreement between mean measured and predicted resting energy expenditure with the exception of the Harris-Benedict equation with an injury factor of 1.3. The results of this pilot study suggest that, for an individual, the limits of agreement are wide, and clinically important differences in resting energy expenditure would be obtained. Clinicians need to be aware of the limitations of the use of resting energy expenditure prediction equations for individuals.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The agreement between measured and predicted resting energy expenditure in patients with pancreatic cancer — A pilot study

Bauer

Reeves²,

Capra³

2003

Clinical Nutrition

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“…It is well known that PN can contribute to hyperglycaemia and hypertriacylglycerolaemia [8]. Moreover, there is considerable evidence that PN can be responsible for adverse outcomes.…”

Section: Does Pn Influence Outcomes In the Critically Ill?mentioning

confidence: 99%

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

2007

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“…9 Abundant evidence points to the dietary effects of a high carbohydrate diet on hepatic lipogenesis. [53][54][55][56][57] A study of transcriptional rate, messenger RNA concentration and enzyme induction for lipogenic enzymes in rat liver showed that fatty acid synthesis and triglyceride levels in the liver were greatly increased by a high carbohydrate diet. 56 A high-carbohydrate, fat-free diet has also been shown to induce fatty acid synthase, the last enzyme of the fatty acid synthesis pathway.…”

Section: Kwashiorkor and Protein Calorie Malnutritionmentioning

confidence: 99%