Variations in the measurement of resting energy expenditure in children with cystic fibrosis

Abstract

Objective: To investigate in children with cystic fibrosis (CF) and children without CF: (1) the test -retest reproducibility of a 20 min resting energy expenditure (REE) measurement; and (2) the long-term reproducibility of REE measurements in children with CF using longitudinal data. Design: Cross-sectional study and longitudinal cohort. Setting: A tertiary referral paediatric hospital. Subjects: A total of 31 (11 male, 20 female) children (aged 12.8 AE 3.6 y) with CF and 32 (14 male, 18 female) healthy children without CF (aged 12.2AE 2.3 y) were enrolled in the short-term reproducibility study. Long-term REE measurement reproducibility was assessed in another 14 children (5 male, 9 female) with CF, comparing their initial REE measurement with a subsequent measurement 1 -2 y later. Methods: All children had measurements of height, weight, skinfold thickness and indirect calorimetry. Results: There was no statistically significant difference in REE between repeated measurements in children with CF (mean AE s.d., 6240AE 1280 and 6220 AE 1315 kJ=24 h) and in the children without CF (6040 AE 956 and 6015 AE 943 kJ=24 h). For the children with CF, the intraclass correlation coefficient was 0.99 and for children without CF the intraclass correlation coefficient was 0.97. The measurement errors were 119 and 177 kJ, respectively. Approximately 80% of the variation in REE in the CF group and 70% in the group without CF was explained by fat-free mass (FFM). Analysis of the longitudinal CF data show there was no difference in REE between a child's first measurement (5140 AE 1140 kJ) and their subsequent measurement (5460 AE 1190 kJ), after adjustment for changes in body size between the measurements. Conclusion: This study has demonstrated that a short-term 20 min REE measurement is reproducible and therefore valid in children with CF and children without CF. These results also indicate that in children with CF, long-term REE measurements are reproducible.

Comparison of resting energy expenditure in bronchopulmonary dysplasia to predicted equation

“…Children with chronic lung disease of prematurity present malnutrition with a decrease in FM and in low metabolic FFM (Goran et al, 1994;Ashley et al, 2001;Atkinson, 2001;Fok et al, 2001). REE, for these reasons, prediction equation should be precisely correlated with age in the population with BPD.…”

“…Values automatically selected to compute individual REE using Weir's formula were those for which the CV was less than 10% for both VO 2 and VCO2, and was less than 10% for both VO 2 and VCO2, and was less than 5% for RQ (Ashley et al, 2001). Values with a higher variation were automatically excluded from REE computing by 'the built in sensitive artifact algorithm' of the Deltatrac II.…”

Balanço energético em crianças e adolescentes com bronquiolite obliterante pós-infecciosa

“…Além disso, a semelhança existente entre os grupos quanto à MM, que é o principal preditor do gasto energético 22 , também poderia explicar a falta de diferença do GER entre os grupos. Ashley et al 23 corroboram, em seu estudo, o importante papel da MM como preditora do gasto energético, pois afirmam que cerca de 70% a 80% das variações do GER podem ser atribuídas à MM. Os presentes achados assemelham-se a estudos em meninos pré-púberes com asma 16 , em meninos chineses obesos e não obesos 24 , em crianças com fibrose cística 23 e em adolescentes com excesso de peso, asmáticos eutróficos e não asmáticos com excesso de peso 25 , os quais também não encontraram diferenças estatisticamente significantes no que se refere ao GER.…”

“…Acredita-se que, assim como para o GER, a estabilidade clínica exigida para participação tenha interferido no resultado encontrado, pois o esforço realizado para o trabalho ventilatório, o estresse da resposta inflamatória à injúria e o uso de determinadas medicações, nos períodos de piora clínica, podem aumentar o gasto energético. Ashley et al 23 , que estudaram o gasto energético em crianças com fibrose cística clinicamente estáveis, declaram que se deve atentar para as extrapolações com crianças com doença pulmonar exacerbada. Além disso, Müller & Bosy--Westphal 31 ressaltam que medições de gasto energético em crianças com doenças pulmonares crônicas são difíceis, em razão do desconforto respiratório e variações na atividade da doença, resultando em baixa reprodutibilidade.…”

Impact of Intravenous Antibiotic Therapy on Total Daily Energy Expenditure and Physical Activity in Cystic Fibrosis Children with Pseudomonas aeruginosa Pulmonary Exacerbation

“…The manufacturer certified a coefficient of variation (CV) of Ͻ2% for each measurement of V CO 2 and V O 2 flows and the RQ. Values automatically selected to compute individual REE using the Weir formula were those for which the CV was less than 10% for both V O 2 and V CO 2 , and was less than 5% for RQ (31)(32)(33). Values with a higher variation were automatically excluded from REE computing by the "built in sensitive artifact algorithm" of the Deltatrac II.…”