The effect of age and body mass index on energy expenditure of critically ill medical patients

Christin Hölzel,Sirak Petros,Lorenz Weidhase

doi:10.1038/s41430-020-00747-8

Christin Hölzel, Sirak Petros + Show 1 more

Open Access

https://doi.org/10.1038/s41430-020-00747-8

Copy DOI

Abstract

BackgroundData on the influence of age and body mass index (BMI) on energy metabolism of the critically ill are heterogeneous. Due to the increasingly aging critically ill population, investigation on age- and BMI-specific energy metabolism is relevant.MethodsA total of 394 indirect calorimetry measurements were conducted on 348 critically ill adult medical patients, including 46 repeat measurements after 3.6 ± 4.3 days. Measured resting energy expenditure (MREE) was compared for age groups, BMI, and gender. Predicted energy expenditure (PEE) using the Penn State, Swinamer, and Ireton-Jones equations and the ACCP recommendations was also compared with MREE.ResultsThe patients were 65.6 ± 14.5 years old. Their mean Acute Physiology and Chronic Health Evaluation II score was 27.6 ± 7.8. Mean BMI was 27.8 ± 8.4 kg/m2, and 25.6% were obese. MREE adjusted for ideal body weight decreased with increasing age, while it increased with increasing BMI. Age, BMI, and gender are independent determinants of MREE after adjusting for clinical factors (R2 = 0.34). All four prediction equations showed a proportional bias, with the Penn State equation performing acceptably. In 46 patients with repeat indirect calorimetry, there was no significant difference between the first and second MREE (p = 0.62).ConclusionsAge, BMI, and gender are independent determinants of resting energy expenditure in critically ill adults. Variations between measured and predicted energy expenditure are considerable. Should prediction equations be used, their performance in the specific population should be taken into consideration. Repeat indirect calorimetry may not always be necessary. However, this may depend on the length of stay and the extent of stress.

Highlights

Defining the optimal energy requirement of the critically ill patient still remains a clinical challenge
This study on a large number of critically ill adult medical patients showed a decrease in measured EE with increasing age
Frankenfield has described in his recent detailed retrospective analysis of data from 826 critically ill patients that aging is associated with a nonlinear decrease in resting EE [24]

Summary

Introduction

Defining the optimal energy requirement of the critically ill patient still remains a clinical challenge. The proportion of the aging population in the intensive care unit (ICU) is continuously increasing [13,14,15]. This development may have a considerable influence on how predictive equations are to be applied in this ICU subpopulation. While the influence of age on EE has been studied in a large healthy population [16,17,18], publications on measured EE in the critically ill mostly included a relatively small subgroup of elderly patients. Measured resting energy expenditure (MREE) was compared for age groups, BMI, and gender. Predicted energy expenditure (PEE) using the Penn State, Swinamer, and Ireton-Jones equations and the ACCP recommendations was compared with MREE

Objectives

Methods

Results

Conclusion