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How accurate are resting energy expenditure prediction equations in obese trauma and burn patients?
JPEN J Parenter Enteral Nutr 2008 Jul-Aug; 32(4):420-6JJ

Abstract

BACKGROUND

While the prevalence of obesity continues to increase in our society, outdated resting energy expenditure (REE) prediction equations may overpredict energy requirements in obese patients. Accurate feeding is essential since overfeeding has been demonstrated to adversely affect outcomes.

OBJECTIVES

The first objective was to compare REE calculated by prediction equations to the measured REE in obese trauma and burn patients. Our hypothesis was that an equation using fat-free mass would give a more accurate prediction. The second objective was to consider the effect of a commonly used injury factor on the predicted REE.

METHODS

A retrospective chart review was performed on 28 patients. REE was measured using indirect calorimetry and compared with the Harris-Benedict and Cunningham equations, and an equation using type II diabetes as a factor. Statistical analyses used were paired t test, +/-95% confidence interval, and the Bland-Altman method.

RESULTS

Measured average REE in trauma and burn patients was 21.37 +/- 5.26 and 21.81 +/- 3.35 kcal/kg/d, respectively. Harris-Benedict underpredicted REE in trauma and burn patients to the least extent, while the Cunningham equation underpredicted REE in both populations to the greatest extent. Using an injury factor of 1.2, Cunningham continued to underestimate REE in both populations, while the Harris-Benedict and Diabetic equations overpredicted REE in both populations.

CONCLUSIONS

The measured average REE is significantly less than current guidelines. This finding suggests that a hypocaloric regimen is worth considering for ICU patients. Also, if an injury factor of 1.2 is incorporated in certain equations, patients may be given too many calories.

Authors+Show Affiliations

University of Kansas School of Medicine, Department of Surgery, University of Kansas Hospital, Kansas City, KS 66160, USA. cstucky@kumc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18596313

Citation

Stucky, Chee-Chee H., et al. "How Accurate Are Resting Energy Expenditure Prediction Equations in Obese Trauma and Burn Patients?" JPEN. Journal of Parenteral and Enteral Nutrition, vol. 32, no. 4, 2008, pp. 420-6.
Stucky CC, Moncure M, Hise M, et al. How accurate are resting energy expenditure prediction equations in obese trauma and burn patients? JPEN J Parenter Enteral Nutr. 2008;32(4):420-6.
Stucky, C. C., Moncure, M., Hise, M., Gossage, C. M., & Northrop, D. (2008). How accurate are resting energy expenditure prediction equations in obese trauma and burn patients? JPEN. Journal of Parenteral and Enteral Nutrition, 32(4), pp. 420-6. doi:10.1177/0148607108319799.
Stucky CC, et al. How Accurate Are Resting Energy Expenditure Prediction Equations in Obese Trauma and Burn Patients. JPEN J Parenter Enteral Nutr. 2008;32(4):420-6. PubMed PMID: 18596313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How accurate are resting energy expenditure prediction equations in obese trauma and burn patients? AU - Stucky,Chee-Chee H, AU - Moncure,Michael, AU - Hise,Mary, AU - Gossage,Clint M, AU - Northrop,David, PY - 2008/7/4/pubmed PY - 2008/10/22/medline PY - 2008/7/4/entrez SP - 420 EP - 6 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 32 IS - 4 N2 - BACKGROUND: While the prevalence of obesity continues to increase in our society, outdated resting energy expenditure (REE) prediction equations may overpredict energy requirements in obese patients. Accurate feeding is essential since overfeeding has been demonstrated to adversely affect outcomes. OBJECTIVES: The first objective was to compare REE calculated by prediction equations to the measured REE in obese trauma and burn patients. Our hypothesis was that an equation using fat-free mass would give a more accurate prediction. The second objective was to consider the effect of a commonly used injury factor on the predicted REE. METHODS: A retrospective chart review was performed on 28 patients. REE was measured using indirect calorimetry and compared with the Harris-Benedict and Cunningham equations, and an equation using type II diabetes as a factor. Statistical analyses used were paired t test, +/-95% confidence interval, and the Bland-Altman method. RESULTS: Measured average REE in trauma and burn patients was 21.37 +/- 5.26 and 21.81 +/- 3.35 kcal/kg/d, respectively. Harris-Benedict underpredicted REE in trauma and burn patients to the least extent, while the Cunningham equation underpredicted REE in both populations to the greatest extent. Using an injury factor of 1.2, Cunningham continued to underestimate REE in both populations, while the Harris-Benedict and Diabetic equations overpredicted REE in both populations. CONCLUSIONS: The measured average REE is significantly less than current guidelines. This finding suggests that a hypocaloric regimen is worth considering for ICU patients. Also, if an injury factor of 1.2 is incorporated in certain equations, patients may be given too many calories. SN - 0148-6071 UR - https://www.unboundmedicine.com/medline/citation/18596313/How_accurate_are_resting_energy_expenditure_prediction_equations_in_obese_trauma_and_burn_patients L2 - https://doi.org/10.1177/0148607108319799 DB - PRIME DP - Unbound Medicine ER -