Energy Gap between Doubly Labeled Water-Based Energy Expenditure and Calculated Energy Intake from Recipes and Plate Waste, and Subsequent Weight Changes in Elderly Residents in Japanese Long-Term Care Facilities: CLEVER Study.

Yuki Nishida,Satoshi Nakae,Yosuke Yamada,Hiroyuki Shirato,Shigeho Tanaka,Hirohiko Hirano,Fuminori Katsukawa,Satoshi Sasaki

doi:10.3390/nu12092677

Abstract

Unintentional weight loss is a major frailty component; thus, assessing energy imbalance is essential for institutionalized elderly residents. This study examined prediction errors of the observed energy intake (OEI) against the actual energy intake obtained from the doubly labeled water (DLW) method and clarified the relationship between the energy gap obtained by subtracting total energy expenditure (TEE) from OEI and subsequent weight changes in elderly residents in long-term care facilities. Overall, 46 participants were recruited in Japan. TEE was measured using the DLW method, and OEI was calculated from recipes and plate waste simultaneously over a 14–15-day period at baseline. The total energy intake (TEIDLW) was determined on the basis of DLW and weight changes during the DLW period. The weight was longitudinally tracked monthly for 12 months in the 28 residents who still lived at the facilities. OEI was higher than TEIDLW by a mean of 232 kcal/day (15.3%) among 46 residents at baseline. The longitudinal data of 28 residents showed that the energy gap tended to be correlated with the slope of weight change (ρ = 0.337, p = 0.080) and the median value was significantly lower in the weight loss group (152 kcal/day) than in the weight gain group (350 kcal/day) (p < 0.05). In conclusion, weight loss could occur at Japanese long-term care facilities even if the difference obtained by subtracting TEE from OEI was positive because OEI was overestimated by more than 200 kcal/day.

Highlights

Weight loss is related to the malnutrition and mortality of elderly residents living in long-term care facilities [1,2]
The results showed that the observed energy intake (OEI) was higher than the TEIDLW by more than 200 kcal/day, and that weight loss occurred even if the energy gap calculated by subtracting total energy expenditure (TEE) from OEI was positive
Both groups had a positive energy gap on average, the energy gap was significantly lower in the weight loss group compared to the weight gain group, and tended to be correlated with the slope of weight change

Summary

Introduction

Weight loss is related to the malnutrition and mortality of elderly residents living in long-term care facilities [1,2]. The appropriate energy requirements of elderly residents need to be set to prevent weight loss. The methods used to determine energy requirements in long-term care facilities have not been verified. The Harris–Benedict equation is still used to predict the basal metabolic rate (BMR) for determining the energy requirement in most Japanese facilities, despite the fact that other BMR equations are more appropriate for older adults [4]. The staff at the facilities do not know the appropriate amount of food for the older residents. It is important to establish a method for calculating the energy requirements of residents of long-term care facilities

Objectives

Methods

Discussion

Conclusion