Standard medical nutrition therapy of 25 kcal/kg ideal bodyweight/day often does not reach even resting energy expenditure for patients with type 2 diabetes

Abstract

Aims/Introduction: In Japan, an ideal bodyweight (IBW) calculated by 22 9 height (m) 2 has commonly been used in the planning of medical nutrition therapy (MNT). However, there have been concerns regarding calorie deficits in fulfilling resting energy expenditure (REE) for patients with type 2 diabetes undergoing MNT as defined by 25 kcal/kg IBW/day. The objective of the present study was to measure REE in patients with type 2 diabetes and verify the validity of MNT with 25 kcal/kg IBW/day. Materials and Methods: A retrospective cross-sectional study was carried out in 52 patients with type 2 diabetes (mean age was 65.9 -7.3 years, bodyweight 65.0 -11.3 kg, body mass index 24.9 -3.8 kg/m 2 ). REE was measured by indirect calorimetry. Results: The mean REE was 1,601.0 -253.1 kcal/day. Assuming that all patients strictly observed daily energy intake as 25 kcal/kg IBW/day, 41 of 52 patients (78.9%) did not reach their REE. The greater the bodyweight, the greater the difference between assumed energy intake as 25 kcal/kg IBW and REE. Conclusions: We call attention to the potential risk of total dietary energy intake set to 25 kcal/kg IBW/day. Clinicians should carefully plan MNT to not fall below a patient's REE to prevent sarcopenia and ensure MNT continuity.

Resting energy expenditure based on equation estimation can predict renal outcomes in patients with type 2 diabetes mellitus and biopsy-proven diabetic kidney disease

“…The nutritional consensus statements advocate for an energy intake of 25-35 kcal/kg/d for patients with CKD [ 29 ]. Despite this, a multitude of studies have showed that the energy intake of patients with CKD [ 30 ] and T2DM [ 31 ] are seriously insufficient. However, individually characterizing energy intake for each patient can be a huge challenge.…”

Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023)

“…Previously, the target energy intake for critically ill patients has been recommended as 25–30 kcal/kg/day [ 84 ]. However, the formula used for this estimation was developed based on energy expenditure outside the acute phase [ 85 , 86 ], and whether this is truly optimal for critically ill conditions remains unclear. Moreover, opinions vary depending on the timing, particularly in the early acute phase (the first 2–3 days after ICU admission) when it overlaps with the peak of invasiveness and inflammation, necessitating cautious nutrition delivery [ 87 ].…”