Resting Energy Requirements Research Articles

Factors Associated with Adverse Outcomes during parenteral Nutrition Administration in Dogs and Cats

Parenteral nutrition (PN) is increasingly used to support hospitalized dogs and cats. Published assessments of outcome are limited. Evaluate type and prevalence of complications and risk factors for death and complications in dogs and cats receiving PN. Three hundred and nineteen dogs and 112 cats that received PN at a teaching hospital between 2000 and 2008. Retrospective case review. Diagnosis, duration of PN administration, concurrent enteral feeding, death, and mechanical, septic, and metabolic complications were abstracted from medical records. Association of each parameter with complications and death was analyzed by binary logistic regression. Pancreatitis was the most common diagnosis (109/319 dogs, 34/112 cats), and 137/319 dogs and 51/112 cats died. Dogs and cats received 113 ± 40% and 103 ± 32% of resting energy requirement, respectively. Mechanical (81/319 dogs, 16/112 cats) and septic (20/319 dogs, 6/112 cats) complications were not associated with death (P > .05). Hyperglycemia was the most common metabolic complication (96/158 dogs, 31/37 cats). Hypercreatininemia in dogs (8/79) was the only complication associated with death (P < .01). Chronic kidney disease in dogs, hepatic lipidosis in cats, and longer duration of inadequate caloric intake before PN in both species were negatively associated with survival (P < .05). Factors positively associated with survival included longer duration of PN administration in both species, enteral feeding in cats with any disease, and enteral feeding in dogs with respiratory disease (P < .05). PN can be effectively used to provide the energy requirements of most critically ill dogs and cats. Most complications accompanying PN administration do not affect survival.

Effect of intravenous administration of dextrose on coagulation in healthy dogs

To investigate effects of IV administration of dextrose on coagulation in healthy dogs. 7 dogs. Thromboelastography and coagulation panel analysis were used to assess coagulation. Samples (S1 through S9) were collected during the study phases: phase 0 (S1 [baseline]); phase 1 (S2 and S3), infusion of crystalloid fluid without dextrose; phase 2 (S4 and S5), high-rate dextrose infusion; phase 3 (S6, S7, and S8), moderate-rate dextrose infusion; and phase 4 (S9), discontinuation of fluids for 24 hours. In phase 3, dogs were allocated to 2 groups; 1 was administered dextrose at a rate comparable to total parental nutrition (40% of resting energy requirement; group A), and 1 was administered dextrose at rates equaling 70% to 90% of resting energy requirement (group B). Blood glucose concentration was measured every 2 hours. No dogs had clinically relevant sustained hyperglycemia. Maximum amplitude and elastic shear modulus were significantly lower at S6 than at S1 through S4. Concentration of D-dimer was significantly higher at S6 than at S1, S3, and S4 and significantly higher at S5 than at S3. Prothrombin time was significantly prolonged at S3, S5, S7, S8, and S9, compared with the value at S1. Activated partial thromboplastin time was significantly prolonged at S5 and S6, compared with values at S1, S2, S3, S4, and S9. IV administration of dextrose to healthy dogs at rates comparable to or higher than those for conventional parenteral nutrition resulted in mild but clinically unimportant interference with coagulation.

The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients

To determine whether nutritional support guided by repeated measurements of resting energy requirements improves the outcome of critically ill patients. This was a prospective, randomized, single-center, pilot clinical trial conducted in an adult general intensive care (ICU) unit. The study population comprised mechanically ventilated patients (n = 130) expected to stay in ICU more than 3 days. Patients were randomized to receive enteral nutrition (EN) with an energy target determined either (1) by repeated indirect calorimetry measurements (study group, n = 56), or (2) according to 25 kcal/kg/day (control group, n = 56). EN was supplemented with parenteral nutrition when required. The primary outcome was hospital mortality. Measured pre-study resting energy expenditure (REE) was similar in both groups (1,976 ± 468 vs. 1,838 ± 468 kcal, p = 0.6). Patients in the study group had a higher mean energy (2,086 ± 460 vs. 1,480 ± 356 kcal/day, p = 0.01) and protein intake (76 ± 16 vs. 53 ± 16 g/day, p = 0.01). There was a trend towards an improved hospital mortality in the intention to treat group (21/65 patients, 32.3% vs. 31/65 patients, 47.7%, p = 0.058) whereas length of ventilation (16.1 ± 14.7 vs. 10.5 ± 8.3 days, p = 0.03) and ICU stay (17.2 ± 14.6 vs. 11.7 ± 8.4, p = 0.04) were increased. In this single-center pilot study a bundle comprising actively supervised nutritional intervention and providing near target energy requirements based on repeated energy measurements was achievable in a general ICU and may be associated with lower hospital mortality.

Helping understand nutritional gaps in the elderly (HUNGER): A prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients

Malnutrition and poor intake during hospitalisation are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. The aim of this study was to measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome. Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia. Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding. Inadequate nutritional intake is common, and patient factors contributing to poor intake should be considered in designing nutritional interventions.

The Total Amount of Energy Delivered by A Brazilian Hospital Catering does not Meet Patient Requirements as Measured by Indirect Calorimetry

The literature is controversial regarding the dietary recommendations for hospitalized patients in Brazil. Objective: We aimed to determine whether the energy content of the diet for hospitalized patients met their energy requirements measured by indirect calorimetry. Methods: Cross-sectional study conducted on adult hospitalized patients of both sexes. The prescription food was checked by reading the charts. Nutritional status was evaluated on the basis of weight, abdominal circumference (AbC), arm circumference (AC), body mass index and waist/hip ratio (WHR). The resting energy requirements of the patients were determined by indirect calorimetry. The diets offered were collected on 3 random non-consecutive days. Total nitrogen, lipid, water, ash and carbohydrate content of the menus were determined. Patients receiving a general or low-sodium diet by the oral route participated in the study. The Student T test was used to analyze the differences in energy expenditure between individuals. The association between gender and percent adequacy of the diet was calculated by the Fisher exact test. The level of significance was set at p < 0.05. Results: We studied 46 adult patients of both genders (29 women and 17 men) aged 45 ± 16 years. Anthropometric evaluation re-vealed a mean weight of 72 ± 26 kg, BMI of 28 ± 10 kg/m². 78% of the patients received energy above their require-ments, with this value increasing to 82% when obese patients were excluded. Conclusion: Since the hospital diet is an important and often vital resource for the recovery of patients and in view of the high prevalence of undernutrition or obesity, it is fundamental to adjust it to the intra-hospital reality.

Prediction of resting energy requirements in people taking weight‐inducing antipsychotic medications

AbstractAim: The purpose of the present study was to determine whether the regression equations published by Mifflin are suitable for the prediction of resting metabolic rate in people taking weight‐inducing antipsychotic medications.Methods: Resting metabolic rate was measured using indirect calorimetry in 45 people with psychotic illnesses who had been taking atypical antipsychotic medications for more than six months. Predicted resting metabolic rate was calculated using the Mifflin, Harris‐Benedict and Schofield equations. The limits of agreement method were used to compare measured and predicted resting metabolic rate.Results: In men, the prediction equations significantly overestimated resting metabolic rate. There was a systematic variation in the bias using the Mifflin equation. The limits of agreement using the Harris‐Benedict and Schofield equations were 2793 and 3014 kJ/day, respectively. In women, predictions of resting metabolic rate using the Harris‐Benedict equation had the lowest limits of agreement (1008 kJ/day) compared with 1978 kJ for the Mifflin and 3157 kJ/day for the Schofield equations, respectively.Conclusion: The present study does not support the recent suggestion that the Mifflin equation is the most suitable prediction equation to determine resting metabolic rate in people taking antipsychotic medications. In men, it may be advisable to reduce the estimate provided using the Harris‐Benedict or Schofield equations by 840 kJ/day. The Harris‐Benedict equation provided the ‘best estimate’ of resting energy requirements in women taking antipsychotic medications.

Effects of nutritional support on hospital outcome in dogs and cats

Investigate the effects of assisted nutritional support on hospital outcome in dogs and cats, and the relationship between hospital outcome and energy intake, body condition score (BCS), physical status score, and type of nutritional support used. Retrospective analysis of hospitalized animals. Teaching Veterinary Hospital. Four hundred and sixty-seven dogs and 55 cats. Routine clinical nutritional support. The following variables were recorded for each animal: energy intake, body weight at admission and discharge, BCS, physical status score, and type of nutritional support used. Disease severity was negatively associated with hospital outcome and energy intake (P=0.009). Energy intake was positively associated with hospital discharge (P<0.001). Outcome may be related to BCS, with discharge rates of 73% for animals with low BCS, and 84.7% for those at an ideal BCS or overweight (P=0.04). Sixty-four percent of animals showed voluntary food intake (92.9% were discharged), 19.0% received enteral support (71.8% were discharged), 7.0% were forced fed (75.0% were discharged), 6.0% received parenteral support (61.9% were discharged), and 4.0% did not receive calories (38.4% were discharged), suggesting a possible relationship between the type of nutritional support, energy intake, and outcome (P=0.009). Energy supply, even if modest and close to resting energy requirements appears to be positively associated with hospital discharge. However, disease severity was the main negative factor on outcome and also had a negative effect on energy intake, making it difficult to separate the effects of both factors when interpreting hospital discharge. Thin animals with low BCS had greater mortality.

Evaluation of calorie density and feeding directions for commercially available diets designed for weight loss in dogs and cats

To determine range of calorie density and feeding directions for commercially available diets designed for weight management in dogs and cats. Cross-sectional study. 93 diets (44 canine diets and 49 feline diets) that had a weight management claim with feeding directions for weight loss or implied weight management claims. Calorie density was collected from product labels or by contacting manufacturers. Recommended feeding directions for weight loss were compared with resting energy requirement (RER) for current body weight by use of a standard body weight (36.4 kg [80 lb] for canine diets and 5.5 kg [12 lb] for feline diets). Calorie density for the 44 canine diets ranged from 217 to 440 kcal/cup (median, 301 kcal/cup) and from 189 to 398 kcal/can (median, 310 kcal/can) for dry and canned diets, respectively. Calorie density for the 49 feline diets ranged from 235 to 480 kcal/cup (median, 342 kcal/cup) and from 78 to 172 kcal/can (median, 146 kcal/can) for dry and canned diets, respectively. Recommended calorie intake for weight loss in dogs ranged from 0.73 to 1.47 x RER (median, 1.00 x RER) and for weight loss in cats ranged from 0.67 to 1.55 x RER (median, 1.00 x RER). Diets ranged from $0.04 to $1.11/100 kcal of diet (median, $0.15/100 kcal of diet). Wide variation existed in recommended calorie intake, kilocalories, and cost for diets marketed for weight loss in pets. This variability could contribute to challenges of achieving successful weight loss in pets.

Galactose promotes fat mobilization in obese lactating and non‐lactating women

BackgroundGalactose consumption results in a lower rise in plasma glucose and insulin concentrations when compared to glucose. The lower insulin might promote lipolysis during meal absorption.HypothesisAn isocaloric galactose drink, when compared to glucose, will sustain fat mobilization during meal consumption while not adversely affecting milk production.Subjects5 healthy, obese (BMI 34.4±2.4), exclusively breastfeeding and 5 non‐lactating (BMI 36.3±1.3) women were studied in a crossover, randomized, single blinded design. During 2d on both occasions, subjects received drinks providing 70% of the daily resting energy requirement (RMR) of which glucose or galactose provided 55% of RMR. Primary outcome variables were: rates of appearance (Ra) of glycerol, glucose and palmitate, milk production, substrate and hormone concentrations, energy expenditure and substrate oxidation.ResultsIn all subjects, during galactose, as compared to glucose feeding, plasma glucose, insulin and C‐peptide were lower (p&lt;0.05) while FFA and glycerol were higher (p&lt;0.01). Glucose Ra was 72% lower and glycerol and palmitate Ra were 39 and 53 % higher (p&lt;0.01) during galactose consumption. Glycerol Ra ( μmol·kg−1·min−1) was higher during galactose than glucose feeding in both control (2.0±0.3 vs. 1.4±0.2, p&lt;0.05) and lactating women (2.2±0.4 vs. 1.7±0.3, p&lt;0.01). Milk production, energy expenditure and substrate oxidation were similar between the two sugars.ConclusionsConsumption of galactose sustains fat mobilization during meal absorption. Thus; galactose might facilitate body fat loss in obese women. RO1DK 55478, HD 37857, MO1‐RR‐00188‐34.

Abnormal Insulin Sensitivity Persists up to Three Years in Pediatric Patients Post-Burn

The acute hypermetabolic response post-burn is associated with insulin resistance and hyperglycemia, significantly contributing to adverse outcome of these patients. The aim of the study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree of insulin resistance in severely burned children for up to 3 yr after the burn injury. A total of 194 severely burned pediatric patients, admitted to our institute between 2002 and 2007, were enrolled in this prospective study and compared to a cohort of 95 nonburned, noninjured children. Urinary cortisol, epinephrine, and norepinephrine, serum cytokines, and resting energy requirements were determined at admission and 1, 2, 6, 9, 12, 18, 24, and 36 months post-burn. A 75-g oral glucose tolerance test was performed at similar time points; serum glucose, insulin, and C-peptide were measured; and insulin sensitivity indices, such as ISI Matsuda, homeostasis model assessment, quantitative insulin sensitivity check index, and ISI Cederholm, were calculated. Statistical analysis was performed by ANOVA with Bonferroni correction with significance accepted at P < 0.05. Urinary cortisol and catecholamines, serum IL-7, IL-10, IL-12, macrophage inflammatory protein-1b, monocyte chemoattractant protein-1, and resting energy requirements were significantly increased for up to 36 months post-burn (P < 0.05). Glucose values were significantly augmented for 6 months post-burn (P < 0.05), associated with significant increases in serum C-peptide and insulin that remained significantly increased for 36 months compared to nonburned children (P < 0.05). Insulin sensitivity indices, ISI Matsuda, ISI quantitative insulin sensitivity check index, and homeostasis model assessment were abnormal throughout the whole study period, indicating peripheral and whole body insulin resistance. The insulinogenic index displayed physiological values, indicating normal pancreatic beta-cell function. A severe burn is associated with stress-induced insulin resistance that persists not only during the acute phase but also for up to 3 yr post-burn.

Energy Requirements of Pediatric Patients With Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

The primary purpose of this study was to compare the measured resting energy requirements (MREE) of children with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with that of children with burns of similar size. A secondary goal was to develop a predictive equation useful in estimating the energy of children with SJS/TEN. This retrospective study included 30 patients admitted to our pediatric burn unit between 12/91 and 03/06. All patients were admitted within 10 days of injury and had at least 1 metabolic cart measurement. Fifteen patients with SJS/TEN comprised group 1. Group 2 consisted of 15 burn patients matched for total wound size, age, preinjury weight, and gender. Caloric intake and discharge weight (percent of preburn weight) were recorded. The energy needs of the SJS/TEN group were 22% less than the burn group. Correlation between MRE x 1.3 and caloric intake was 0.89 for the SJS/TEN group and 0.92 for the burn group (P < .0001). Both the SJS/TEN and burn groups were managed by nutrition goals based on the MREE x 1.3, and patients were 95.1% +/- 6.3% and 98.9% +/- 6% of preinjury weight at discharge, respectively, in each group. An equation for the estimation of energy requirements in pediatric SJS/TEN patients was statistically generated: (24.6 x weight in kg) + (% wound x 4.1) + 940. The energy requirement in pediatric SJS/TEN patients is less than that following burn injury. The application of a 30% factor to MREE is supported in SJS/TEN and thermal injury.

Energy requirement - factors that influence variation in basal metabolic rate.

Abstract Basal metabolic rate (BMR) can be simply defined as the minimum amount of energy the body requires at rest and is commonly measured using indirect calorimetry techniques. Factors that can influence metabolic rate can be technical in nature, owing to the limitations and constraints of the precision of the equipment, or can be biological, linked to the physiology and behaviour of the subject. The principles and assumptions of indirect calorimetry are discussed. It is well documented that body size and composition are the main determinants of resting energy requirements, whereas the influence of chronic or acute changes in disease state is less well documented. Aside from the clinical perspective, accurate measurement of BMR is important as it is used in epidemiological or public health nutrition to calculate total daily requirements and to classify energy intakes. Many factors, such as body composition, age, gender, food amount and composition, diseases, medications, hormonal status and genetic differences, can affect the variability in BMR and thus can lead to errors in classification of population data.

Canine Protein Requirement and Circulating Glucose Concentration During Weight Loss.

Eighteen obese dogs, randomly assigned to three dietary protein level foods, were the subjects of this study to determine the effect of weight loss, at different protein levels, on change in body composition and responsiveness to oral glucose. The experimental protocol was reviewed and approved by the Institutional Animal Care and Use Committee. Responsiveness to glucose was determined through measurement of venous glucose while body composition was determined via dual energy x-ray absorptiometry (DXA). Glucose concentration and DXA were measured before and after weight loss. All foods had identical energy content (2.7 kcal/g), but contained 18.2%, 23.1% and 27.1% protein. The study subjects were provided with food that supplied the resting energy requirement (RER, 70 X wt in kg3/4) while they lost weight. All dogs effectively lost weight resulting in reduced blood glucose (P<0.05, both resting and after an oral glucose challenge). Maximal body protein was maintained during weight loss when the daily ration of food supplied more than 2.4g of protein/kg lean body mass.

Retrospective evaluation of total parenteral nutrition in cats: 40 cases (1991–2003)

AbstractObjective: The purpose of this retrospective study was to evaluate the use of total parenteral nutrition (TPN) in cats, to determine the frequency of complications, and to evaluate risk factors for complications.Design: The medical records of all cats receiving TPN at Tufts University between 1991 and 2003 were reviewed using a standardized data sheet.Setting: University hospital.Animals: Forty cats that received TPN were included in the analysis.Measurements and main results: Complications were classified as metabolic (e.g., hyperglycemia, hypokalemia), mechanical (e.g., catheter dislodgement, cellulitis), or septic (e.g., clinical suspicion of sepsis, in combination with a positive catheter culture). The most common underlying diseases were hepatic disease (n=16), gastrointestinal disorders (n=10), and pancreatitis (n=8). Median duration of TPN administration was 3.7 days (range, 0.3–9.5 days). Of the 40 cats receiving TPN, 26 experienced at least one complication with a total of 45 complications overall. These included metabolic (n=33) and mechanical (n=12). No cases of sepsis were documented. The most common metabolic complication was hyperglycemia (n=9). Most complications were mild and did not require discontinuation of TPN or adjustment of formula. Cats provided with energy above the resting energy requirement (RER) were more likely to develop hyperglycemia than those using RER as the initial calorie goal (P=0.02). Neither the presence nor number of complications impacted the duration of hospitalization or outcome.Conclusions: A more conservative estimate of energy requirements was associated with a lower risk of hyperglycemia. Future studies are warranted to determine the optimal formula and efficacy of TPN in cats.

Investigation of the percentage of prescribed enteral nutrition actually delivered to hospitalized companion animals

AbstractObjective: To investigate the percentage of prescribed enteral nutrition that is actually delivered; the percentage of goal feeds [defined in terms of the animal's estimated resting energy requirement (RER)] that are delivered; and the reasons animals are under or overfed in a small animal teaching hospital.Design: Prospective investigation.Setting: Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania.Animals: All dogs and cats that received tube feeding while admitted to the Ryan Veterinary Hospital during the months of August–December 2003.Interventions: The medical record for each animal was reviewed to determine the feeding prescription, the amount of tube feeds actually delivered, and any reasons why the amount delivered differed from the amount prescribed. The amount prescribed was also compared with the animal's goal feeds which were defined for a patient as 50% RER/day on the first day of feeding and 100% RER/day for the remaining days of hospitalization.Main results: Twenty‐five animals (23 cats and 2 dogs) were enrolled in the study. Animals received a median of 91% (range: 68–100%) of their prescribed feeds/day and a median of 90% (range: 36–133%) of goal feeds/day. Nausea or vomiting and conflict with other treatments were the most common recorded reasons for incomplete feeds.Conclusions: Both prescribed and goal feeds were delivered to the animals in this investigation with a good rate of success. Consultation with the Nutrition Support Service improved the likelihood that prescribed feeds would meet the animal's estimated RER.

Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward

To report the dietary energy and protein intake of undernourished older adults (with and without cognitive impairment) admitted to hospital following a lower limb fracture and to determine whether dietary intakes met estimated requirements. An observational study of a sequential sample. The orthopaedic ward of a South Australian metropolitan teaching hospital. Sixty-eight patients aged > or =70 years screened as undernourished and admitted to hospital following lower limb fracture (50% cognitively impaired) provided 3 to 5 days of dietary data. MAJOR OUTCOME METHODS: Dietary energy and protein intake. Dietary assessment using plate waste methodology and snack record charts commenced within 6 days postinjury and continued for up to five consecutive days or until discharge. Estimated resting energy requirements were calculated and adjusted for activity equivalent to bed rest and physiological stress. Protein requirements were calculated as 1 g/kg/day. Cognition was assessed using the Short Portable Mental Status Questionnaire. Cognitively impaired participants and those without cognitive impairment consumed, mean (95% CI) respectively, 3661 kJ/day (3201, 4121) versus 4208 kJ/day (3798, 4619) and 38 g (33, 44) versus 47 g (41, 52) protein/day. Cognitively impaired participants consumed mean (95% CI) 48% (43, 53) of estimated total energy expenditure and 78% (69, 87) of estimated protein requirements. Orthopaedic fracture patients at greatest nutritional risk, including those with cognitive impairment, do not achieve estimated energy or protein requirements from diet alone. Effective methods of achieving requirements in this vulnerable group are needed before improvements in outcomes will be observed.

The Contribution of Body Protein to the Supply of Energy in Starved Newborn Piglets Is Not Preferentially Suppressed by Intravenous Provision of Glucose and Fat

Newborn piglets were used to study body protein preservation because it is critical to the survival of premature infants. Quantitative estimates of endogenous fuel use were obtained from 12 to 72 h of age in male piglets. Of the 40 piglets used (1300 +/- 205 g, mean +/- SD), 16 served as a 12-h-old body composition reference (R), 16 were starved (S) and received water only, and 8 received supplemental energy (E), obtaining 70% [210 kJ/(kg x d)] of their resting energy requirement as an i.v. mixture of glucose and Intralipid (65:35 energy ratio). Urine was collected continuously from the bladder via an umbilical urachal catheter. Total body water, glycogen, lipid, ash, and Kjeldahl-N were determined on whole-pig homogenates. Comparative slaughter was used to estimate the disappearance of body constituents of S and E pigs from 12 to 72 h of age. Midpoint body weight was used in these calculations. Supplemental energy decreased use of all body energy sources as indicated by the decrease in body dry matter disappearance, 41.6 +/- 8.8 vs. 25.5 +/- 5.9 g/kg (P = 0.0021) and protein (urinary N excretion), 995 +/- 508 vs. 329 +/- 135 mg/kg (P = 0.0119) over 60 h. Supplemental energy did not preferentially spare the percentage of the resting energy expenditure supplied by endogenous body protein (protein 37.6% +/- 9.6 vs. 41.7% +/- 10.4; lipid 25.7% +/- 5.2 vs. 20% +/- 4.1; glycogen 36.8% +/- 7.5 vs. 38.3% +/- 9.9; S vs. E) because it made up approximately 40% of the total in food-deprived and supplemented piglets.

Resting Energy Expenditure in the Parenterally Fed Pediatric Population With Crohn's Disease

Malnutrition is a common sequela of Crohn's disease (CD) and may result in reduced skeletal muscle function and growth retardation. Energy requirements of parenterally fed hospitalized pediatric patients with active CD were measured using indirect calorimetry, to assess whether Food Agriculture Organization (FAO)/World Health Organization (WHO)/United Nations University (UNU) equations provide appropriate estimations of energy requirements in this patient population. Twenty hospitalized patients with active CD fed exclusively via parenteral nutrition (PN) were investigated. A chart review and patient interviews were conducted to assess disease duration, location, laboratory parameters, and symptomology associated with CD. Disease severity was quantified using the Pediatric Crohn's Disease Activity Index. Each subject underwent indirect calorimetry, bioelectrical impedance analysis, and anthropometric assessment once the ordered PN met estimated macronutrient requirements of each patient (predicted resting energy expenditure x1.3). Predicted resting energy expenditure (REE) was determined using the FAO/WHO/UNU equations. REE showed a strong correlation with predicted REE (r(2) = .73, p < .01). Measured REE did not significantly differ from predicted resting energy requirements. This indicates that REE for the parenterally fed pediatric patients with CD can be accurately predicted using the FAO/WHO/UNU equations.

Body-composition differences between African American and white women: relation to resting energy requirements

Body composition differs between African American (AA) and white women, and the resting metabolic rate (RMR) is likely to be lower in AA women than in white women. We tested 2 hypotheses: that AA women have a greater proportion of low-metabolic-rate skeletal muscle (SM) and bone than do white women and that between-race musculoskeletal differences are a function of body weight. Hypothesis 1 was tested by comparing SM, bone, adipose tissue, and high-metabolic-rate residual mass across 22 pairs of matched AA and white women. Magnetic resonance imaging and dual-energy X-ray absorptiometry were used to partition weight into 4 components, and RMR was both calculated from tissue-organ mass and measured. Hypothesis 2 was evaluated by measuring SM, bone, fat, and residual mass in 521 AA and white women with the use of dual-energy X-ray absorptiometry alone. Hypothesis 1: AA women had greater SM ( +/- SD group difference: 1.52 +/- 2.48 kg; P < 0.01) and musculoskeletal mass (1.72 +/- 2.66 kg; P < 0.01) than did white women. RMR calculated from body composition and measured RMR did not differ; RMR estimated by both approaches tended to be lower (approximately 160 kJ/d) in AA women than in white women. Hypothesis 2: SM was significantly correlated with weight, height, age, and race x weight interaction; greater SM in the AA women was a function of body weight. Lower RMRs in AA women than in white women are related to corresponding differences in the proportions of heat-producing tissues and organs, and these race-related body-composition differences increase as a function of body weight.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.