Variability of Resting Energy Expenditure in Infants and Young Children With Intestinal Failure–Associated Liver Disease

Abstract

Objective To determine, in a cohort of young children with intestinal failure (IF), if estimates of basal metabolic rate (BMR) by standard equations, approximate measured REE by indirect calorimetry (IC). Methods IC was performed by dilutional canopy technique. REE measurements were compared to standard, age-based estimation equations (WHO) for BMR. Subjects were classified as hypermetabolic (REE > 110% BMR), hypometabolic (REE < 90% BMR), or normal (REE = 90–110% BMR). Results Twenty-eight IF patients (11 female, 17 male) had an underlying diagnosis of necrotizing enterocolitis (n=10) or a congenital gastrointestinal defect (n=18). Median age was 5.3 months. Median (IQR) REE was 46 (42, 58) kcal/kg/day. Median (IQR) total energy intake provided 209 (172, 257)% of REE, with parenteral nutrition providing 76% (23%) of total energy intake. REE was variable, with 39% (n=11) of measurements hypermetabolic, 39% (n=11) hypometabolic, and the remaining 21% (n=6) normal. Although REE was well correlated with estimated BMR (r = 0.82, P < 0.0001), estimated BMR was not consistently an adequate predictor of REE. BMR over- or under-estimated REE by more than 10 kcal/kg/d in 15/28 (54%) patients. REE was not significantly correlated with severity of liver disease, nutritional status, total energy intake or gestational age. Conclusions Energy expenditure is variable among children with IF and IFALD, with nearly 80% of our cohort exhibiting either hypo- or hypermetabolism. Standard estimation equations frequently do not correctly predict individual REE. Longitudinal studies of energy expenditure and body composition may be needed to guide provision of nutrition regimens.

Resting Energy Expenditure of Children With End‐stage Chronic Liver Disease Before and After Liver Transplantation

“…Our study shows that there is a high degree of variation in REE when it is measured, rather than predicted, and not all patients can be classified as hypermetabolic. This is consistent with findings in children with intestinal failure–related liver disease (19). Classifying children as hypermetabolic based on definitions used for adults may not be that helpful.…”

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“…These findings indicate a possibility of energy intake (prescription) in excess of actual requirement. We have recently reported significant variability in resting energy expenditure in a cohort of children with IF associated liver disease (42). Energy prescriptions based on standard equations may not be accurate and result in a potential for overfeeding in children with IF.…”

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