ESTIMATION OF RESTING ENERGY EXPENDITURE IN PERSON WITH SPINAL CORD INJURY

Abstract

Proper nutrition is an important component of weight management, rehabilitation, and healing of decubitus ulcers in persons with spinal cord injury (SCI). Frequently, decisions regarding the caloric requirement of the person with SCI are based on an estimation of resting energy expenditure (REE) using empirically derived equations for the able-bodied, i.e., Harris Benedict, Long. The dietician's primary objective is to accomplish an optimal balance between the person's nutritional needs and their caloric intake. PURPOSE: Develop and validate a new equation to estimate REE in persons with SCI and to determine if existing equations provide adequate precision for this population. METHODS: Subjects were randomly assigned to either a prediction (PRE, n = 24) or validation (VAL, n = 16) group. All subjects completed a resting energy study after a 12 hr fast. Stepwise regression analysis was performed on PRE group data to derive a new population specific equation (VAREE) to estimate REE. The VAREE was compared (ANOVA) with measured REE (REEMeas); and two equations currently in use clinically namely, Harris Benedict (HB) and Long (kcal/kg). RESULTS: Differences in demographic characteristics (age, height, weight, REEMeas) between the PRE and VAL groups were not significant. The resulting equation from the PRE group was VAREE (kcal) = 413.317+11.447(AL)+13.162(Wt)−0.672(MSI). Where AL is anatomical level of injury, Wt is body weight in kg and MSI is months since injury. The equation accounted for 69% of the variance in the PRE group. When compared in the VAL group the REEMeas, HB and new equation were not different from each other, whereas the Long equation significantly (P < 0.05) over estimated REE. CONCLUSION: Although the new equation performed well in the validation group work continues to improve on the current model. Department of Veterans Affairs, Rehabilitation Research and Development Service