Resting energy expenditure in subjects with and without intermittent claudication

Nutritional Considerations for Peripheral Arterial Disease: A Narrative Review

Those with peripheral arterial disease (PAD) require important considerations with respect to food and nutrition, owing to advanced age, poor diet behaviours and immobility associated with the disease process and co-morbid state. These considerations, coupled with the economic effectiveness of medical nutrition therapy, mandate that dietetic care plays a vital role in the management of PAD. Despite this, optimising dietetic care in PAD remains poorly understood. This narrative review considers the role of medical nutrition therapy in every stage of the PAD process, ranging from the onset and initiation of disease to well established and advanced disease. In each case, the potential benefits of traditional and novel medical nutrition therapy are discussed.

Resting energy expenditure in patients with intermittent claudication and critical limb ischemia

OBJECTIVE

The primary aim of this study was to compare the resting energy expenditure of patients with intermittent claudication and critical limb ischemia. A secondary aim was to identify predictors of resting energy expenditure.

METHODS

One hundred patients limited by intermittent claudication and 40 patients with critical limb ischemia participated in this study. Patients were assessed on resting energy expenditure, body composition, ankle brachial index (ABI), and calf blood flow.

RESULTS

Patients with critical limb ischemia had a lower resting energy expenditure than patients with intermittent claudication (1429 +/- 190 kcal/day vs 1563 +/- 229 kcal/day; P = .004), and higher body fat percentage (34.8 +/- 7.8% vs 31.5 +/- 7.8%; P = .037), higher fat mass (30.0 +/- 9.3 kg vs 26.2 +/- 8.9 kg;P = .016), and lower ABI (0.31 +/- 0.11 vs 0.79 +/- 0.23; P < .001). Resting energy expenditure was predicted by fat free mass (P < .0001), age (P < .0001), ABI (P < .0001), ethnicity (P < .0001), calf blood flow (P = .005), and diabetes (P = .008). Resting energy expenditure remained lower in the patients with critical limb ischemia after adjusting for clinical characteristics plus fat free mass (1473 +/- 27.8 kcal/day [mean +/- SEM] vs 1527 +/- 19.3 kcal/day; P = .031), but it was no longer different between groups after further adjustment for ABI and calf blood flow (1494 +/- 25.2 kcal/day vs 1505 +/- 17.7 kcal/day; P = .269).

CONCLUSION

Resting energy expenditure is decreased with a progression in peripheral arterial disease (PAD) symptoms from intermittent claudication to critical limb ischemia. Furthermore, patients with critical limb ischemia who are most susceptible for decline in resting energy expenditure are older, African American patients with diabetes. The lower resting energy expenditure of patients with critical limb ischemia, combined with their sedentary lifestyle, suggests that they are at high risk for long-term positive energy balance and weight gain.