Comparison of resting energy expenditure measured with metabolic cart and calculated with predictive formulas in critically ill patients on mechanical ventilation

Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.

Net Heart Rate for Estimating Oxygen Consumption in Active Adults

The aim of this study was to verify the accuracy of predicting oxygen consumption (O2) in predominantly aerobic activities based on net heart rate (netHR), sex, and body mass index (BMI) in active adults. NetHR is the value of the difference between the resting HR (HRrest) and the average HR value obtained during a given session or period of physical activity. These activities must be continuous, submaximal, and of a stabilized intensity. The magnitude of the netHR depends mainly on the intensity of the exercise. The HR is measured in beats per minute (bpm). A total of 156 participants, 52 women and 104 men, between the ages of 18 and 81, had their netHR and net oxygen intake (netVO2) assessed. There were 79 participants in group 1 (prediction sample) (52 males and 27 females). There were 77 people in group 2 (validation sample) (52 males and 25 females). The results of the multiple linear regression showed that netVO2 (R2 = 85.2%, SEE = 3.38) could be significantly predicted by sex (p < 0.001), netHR (p < 0.001), and BMI (p < 0.001). The Bland-Altman plots satisfied the agreement requirements, and the comparison of the measured and estimated netVO2 revealed non-significant differences with a trivial effect size. We calculated the formula NetVO2 (mL/(kg·min)) = 16 + 3.67 (sex) + 0.27 (netHR) - 0.57 (BMI) to predict netVO2, where netVO2 is the amount of oxygen uptake (mL/(kg·min)) above the resting value, netHR is the heart rate (beats per minute) above the resting value measured during exercise, sex is equal to zero for women and one for men, and BMI is the body mass index. In addition, based on the knowledge of VO2, it was possible to estimate the energy expenditure from a particular training session, and to determine or prescribe the exercise intensity in MET (metabolic equivalent of task).

Measured versus estimated energy requirement in hospitalized patients

BACKGROUND & AIM

Failure to identify a patient's energy requirement has a variety of consequences both physiological and economical. Previous studies have shown that predictive formulas, including the Harris Benedict equation (HB), both over- and underestimates energy requirement in severely ill patients and healthy younger adults, compared to the golden standard, indirect calorimetry (IC). The comparison between measured and estimated energy requirements in hospitalized patients in regular wards is underreported. The aim of this study was to assess the agreement between measured energy requirements and requirements estimated by HB in the individual hospitalized patients, and to investigate whether those findings were associated with other specific patient characteristics.

METHODS

IC (n = 86) was used to measure resting energy expenditure (REE) and bioimpedance analysis (BIA) (n = 67) was used for body composition in patients admitted to Aalborg University Hospital. Furthermore, height, weight, body mass index, calf circumference, while information regarding hospital ward, vital values, dieticians estimated energy requirements and blood samples were collected in the patients' electronic medical records. Bland-Altman plots, multiple linear regression analysis, and Chi2 tests were performed.

RESULTS

On average a difference between IC compared with the HB (6.2%), dietitians' estimation (7.8%) and BIA (4.50%) was observed (p < 0.05). Association between REE and skeletal muscle mass (SMM) (R2 = 0.58, β = 149.0 kJ), body fat mass (BFM) (R2 = 0.51, β = 59.1 kJ), and weight (R2 = 0.62, β = 45.6 kJ) were found (p < 0.05). A positive association between measured REE and HB were found in the following variables (p < 0.05): CRP, age, surgical patients, and respiratory rate.

CONCLUSION

This study found a general underestimation of estimated energy expenditure compared to measured REE. A positive correlation between measured REE and SMM, BRM and weight was found. Lastly, the study found a greater association between CRP, age, surgical patients, and respiratory rate and a general greater than ±10% difference between measured and estimation of energy requirements.