Total Energy Expenditure In Patients Research Articles

Total energy expenditure in patients with colorectal cancer: associations with body composition, physical activity, and energy recommendations

Total energy expenditure (TEE) data in patients with early-stage cancer are scarce, precluding an understanding of energy requirements. The objective was to cross-sectionally characterize TEE in patients with colorectal cancer (CRC) and to compare measured TEE with energy recommendations. It was hypothesized that TEE would differ according to body mass, body composition, and physical activity level (PAL) and current energy recommendations would have poor individual-level accuracy. Patients with newly diagnosed CRC had resting energy expenditure (REE) measured by indirect calorimetry and TEE by doubly labeled water. Hypermetabolism was defined as REE>110% of that predicted from the Mifflin St.-Jeor equation. Body composition was assessed via DXA. Physical activity was determined as the ratio of TEE to REE (TEE:REE) (PAL) and residual activity energy expenditure (RAEE). TEE was compared with energy recommendations of 25-30 kcal/d and Dietary Reference Intakes (DRIs) using Bland-Altman analyses. Patients were stratified according to median BMI, PAL, and sex-specific ratio of fat mass (FM) to fat-free mass (FFM). Twenty-one patients (M:F 14:7; mean±SD BMI: 28.3±4.9 kg/m2, age: 57±12 y) were included. Most (n=20) had stage II-III disease; 1 had stage IV. Approximately half (n=11) were hypermetabolic; TEE was not different in those with hypermetabolism and REE as a percentage of predicted was not correlated with TEE. Mean±SD TEE was 2473±499 kcal/d (range: 1562-3622 kcal/d), or 29.7±6.3 kcal/kg body weight (range: 20.4-48.5 kcal/kg body weight). Mean±SD PAL was 1.43±0.27. The energy recommendation of 25 kcal/kg underestimated TEE (-12.6%±16.5%, P=0.002); all energy recommendations had wide limits of agreement (the smallest was DRI with measured PAL: -21.2% to 29.3%). Patients with higher BMI and FM:FFM had higher bias using kilocalories per kilogram recommendations; bias from several recommendations was frequently lower (i.e. underestimation) in patients with higher PAL and RAEE. TEE variability was not reflected in energy recommendations and error was related to body weight, body composition, and physical activity. This trial was registered at clinicaltrials.gov as NCT03131921.

Influence of chemotherapy on total energy expenditure in patients with gastrointestinal cancer: A pilot study.

Resting energy expenditure (REE) and physical activity (PA) undergo variations during chemotherapy. The aim of this study was to use a metabolic Holter (SenseWear Armband [SWA]) to assess REE, total energy expenditure (TEE), and PA changes in patients undergoing chemotherapy to ensure the appropriate calorie intake. To our knowledge, this is the first study to do so. Eight patients with gastrointestinal tumors and a Karnofsky performance status of >50 underwent evaluation of the body mass index; REE, TEE, metabolic equivalent, and sleep efficiency were evaluated by SWA. Fat-free mass and fat mass were measured by bioelectrical impedance analysis, muscle strength by handgrip, and dietary intake by food diary. All evaluations were performed before chemotherapy (T0), at mid-treatment (T1), and at the end of treatment (T2). A calorie-equivalent diet to the TEE was recommended to all patients. At T0, a body weight loss of 15.1 ±7.2% in the previous 6mo was observed in all patients. Two patients did not complete treatment. During chemotherapy, thanks to the nutritional counseling, the remaining patients increased their calorie intake (P=0.006) and no significant change was observed in other parameters. The REE calculation measured by SWA was correlated to the Harris-Benedict formula (P≤0.002). The present data excluded significant variations of REE and PA in the course of chemotherapy in patients who do not experience weight loss and who have a Karnofsky performance status of >50. Nutritional counseling based on SWA measurements is useful to support nutritional status in patients undergoing chemotherapy.

Total energy expenditure in stable patients with cystic fibrosis

Background and aims: Undernutrition is a common problem in patients with cystic fibrosis and is associated with a poor prognosis. The two aims of this study were to assess and compare the two main field techniques in the measurement of total energy expenditure and, secondly, to assess total energy expenditure in stable patients and compare with healthy controls.Methods: Resting energy expenditure was measured using indirect calorimetry and total energy expenditure was measured using 24-h heart rate (HR) methodology and doubly isotopically labelled water.Results:Seventeen patients, mean age 23 years and FEV152% predicted and thirteen controls were recruited. Resting energy expenditure was higher in patients 0.24 (0.03) MJ/kg Fat-Free Mass (FFM) compared to controls 0.22 (0.02) MJ/kg FFM,P =0.02. Twenty-four hour heart rate underestimated total energy expenditure, 9.49 (1.85) MJ/day in patients compared to 11.69 (2.79) MJ/day using doubly labelled water. There was no difference in total energy expenditure in patients and controls using both methods, 11.69 (2.79) MJ/day compared to 11.38 (2.71) MJ/day using doubly isotopically labelled water.Conclusions: In clinically stable young adult patients with moderately severe respiratory disease total energy expenditure is comparable to that an a control population despite in increase in resting energy expenditure and both 24-h HR and doubly isotopically labelled water are suitable for use in patients with cystic fibrosis.

172. Total energy expenditure in stable patients with cystic fibrosis

Background and aims: Undernutrition is a common problem in patients with cystic ¢brosis and is associated with a poor prognosis.The two aims of this study were to assess and compare the two main ¢eld techniques in the measurement of total energyexpenditure and, secondly, to assess total energyexpenditure in stable patients andcom- pare withhealthy controls. Methods:Restingenergyexpenditurewasmeasuredusingindirectcalorimetryandtotalenergyexpenditurewasmea- sured using 24-hheart rate (HR) methodology and doubly isotopically labelled water. Results: Seventeenpatients, meanage 23 years and FEV152%predictedandthirteencontrols were recruited. Resting energy expenditure was higher in patients 0.24 (0.03) MJ/kg Fat-Free Mass (FFM) compared to controls 0.22 (0.02) MJ/kg FFM, P=0.02.Twenty-fourhourheartrateunderestimatedtotalenergyexpenditure,9.49(1.85)MJ/dayinpatients compared to 11.69 (2.79)MJ/day using doubly labelled water. There was no diierence in total energy expenditure in patients and controls using both methods,11.69 (2.79) MJ/day compared to11.38 (2.71) MJ/day using doubly isotopi- cally labelled water. Conclusions: Inclinically stableyoungadultpatientswithmoderately severe respiratorydiseasetotalenergyexpendi- tureiscomparabletothatanacontrolpopulationdespiteinincreaseinrestingenergyexpenditureandboth24-hHRand doubly isotopically labelled waterare suitable foruse inpatients with cystic ¢brosis. & 2001Harcourt Publishers Ltd.

Total energy expenditure in patients with small-cell lung cancer: Results of a validated study using the bicarbonate-urea method

The bicarbonate-urea method for measuring CO2 production was applied to eight free-living patients (mean age, 68 ± 10 years; mean weight, 69 ± 10 kg; mean height, 1.65 ± 0.10 m) with unresectable small-cell lung cancer for a period of 1 day (n = 5) or 2 days (n = 3). The basal metabolic rate (BMR) was measured in all subjects. The technique was first validated against whole-body indirect calorimetry over an additional 24-hour period in five of these subjects. The bicarbonate-urea method predicted net CO2 production to be 102.1 ± 3.4% of that measured by whole-body indirect calorimetry, and energy expenditure, 101.5% ± 3.8% of the measured calorimeter value (8.1 ± 1.6 MJ/d). The 24-hour recovery of label in CO2 excreted by the body was 95.6% ± 0.5%. In free-living conditions, the bicarbonate-urea method predicted energy expenditure to be 9.0 ± 2.6 MJ/d. BMR was elevated by a mean of 6% (P < .05) compared with the Schofield standards. The physical activity level ([PAL] the ratio of total energy expenditure [TEE] to BMR) was variable (1.15 to 1.87), but the mean value was only 1.36 ± 0.22, considerably less than that of moderately active healthy subjects with estimated PAL values of 1.55 (P < .05) to 1.65 (P < .01) and the mean results obtained by doubly labeled water (previous studies) in healthy age- and sex-matched subjects. This is the first time a tracer method for measuring CO2 production and energy expenditure has been validated against whole-body 24-hour indirect calorimetry in patients with lung cancer or a systemic inflammatory reaction. The agreement between the two methods is similar to that observed in normal subjects. This is also the first time a tracer method has been used to measure energy expenditure in free-living patients with lung cancer. The results suggest that TEE and the energy requirements necessary to maintain energy balance were not increased despite basal hypermetabolism, because of the associated decrease in physical activity.

Relationships between resting and total energy expenditure in injured and septic patients

Objective: To quantify resting and total energy expenditure in patients who have suffered severe trauma and sepsis. Design: Prospective, unblinded, observational, nonrandomized study. Setting: Critical care unit of a Level I adult trauma center. Patients: Immediate posttrauma patients or trauma patients exhibiting signs of sepsis with multiple organ dysfunction. Interventions: An indirect calorimeter was used to measure energy expenditure at rest (resting energy expenditure) at 0700 and 1900 hrs. The energy expenditure measurement was then continued for up to 12 hrs (total energy expenditure). Clinical data were collected for computation of an illness severity score. Results: Thirteen trauma and 20 septic patients were studied 240 times. All patients were mechanically ventilated. Morphine or fentanyl was infused during 99% of studies. Neuromuscular blocking agents were used in 42% of septic studies. Both the trauma and septic groups were hypermetabolic (mean trauma resting energy expenditure, 36 ± 6 kcal/kg; mean septic resting energy expenditure, 44 ± 8 kcal/kg;p< .05). Total energy expenditure was similar to resting energy expenditure (trauma total energy expenditure = resting energy expenditure × 1.035 ± 0.078, septic total energy expenditure = resting energy expenditure × 1.039 ± 0.071). Total energy expenditure and resting energy expenditure were linearly related (r2 = .89,p< .0001). Conclusions: Trauma and septic patients are hypermetabolic, even when heavily sedated or medically paralyzed. A measurement of resting energy expenditure is a close approximation of total energy expenditure in most patients. (Crit Care Med 1994; 22:1796–1804)

Relationships between resting and total energy expenditure in injured and septic patients

To quantify resting and total energy expenditure in patients who have suffered severe trauma and sepsis. Prospective, unblinded, observational, nonrandomized study. Critical care unit of a Level I adult trauma center. Immediate posttrauma patients or trauma patients exhibiting signs of sepsis with multiple organ dysfunction. An indirect calorimeter was used to measure energy expenditure at rest (resting energy expenditure) at 0700 and 1900 hrs. The energy expenditure measurement was then continued for up to 12 hrs (total energy expenditure). Clinical data were collected for computation of an illness severity score. Thirteen trauma and 20 septic patients were studied 240 times. All patients were mechanically ventilated. Morphine or fentanyl was infused during 99% of studies. Neuromuscular blocking agents were used in 42% of septic studies. Both the trauma and septic groups were hypermetabolic (mean trauma resting energy expenditure, 36 +/- 6 kcal/kg; mean septic resting energy expenditure, 44 +/- 8 kcal/kg; p < .05). Total energy expenditure was similar to resting energy expenditure (trauma total energy expenditure = resting energy expenditure x 1.035 +/- 0.078, septic total energy expenditure = resting energy expenditure x 1.039 +/- 0.071). Total energy expenditure and resting energy expenditure were linearly related (r2 = .89, p < .0001). Trauma and septic patients are hypermetabolic, even when heavily sedated or medically paralyzed. A measurement of resting energy expenditure is a close approximation of total energy expenditure in most patients.

Total energy expenditure in patients with Crohn's disease: measurement by the combined body scan technique.

A combined body scan technique for measuring total energy expenditure (TEE) from energy intake and changes in energy stores is presented. The TEE of 13 patients with Crohn's disease who required nutrition support over a 14-day period was measured. They had a mean TEE of 33 kcal/kg per day. The components of the TEE in these 13 patients were also measured. Seventy percent of the TEE was made up by resting metabolic expenditure, 10% by diet-induced thermogenesis, and the remaining 20% by activity energy expenditure. These patients had a mean activity energy expenditure of 369 kcal/day. The diet-induced thermogenesis was a mean 12.6% increase on the resting metabolic expenditure. Each percent increase was caused by a mean of 210 kcal of energy in either the intravenous nutrition or the enteral nutrition. There was no difference in diet-induced thermogenesis between those having enteral nutrition and those receiving intravenous nutrition. Decreased activity was significantly correlated with increased activity of the disease (r = .7, p < .01). This confirms the belief that patients with Crohn's disease require no more energy (ie, 33 kcal/kg per day) than other patients. If the resting metabolic expenditure is increased through illness, then the activity energy expenditure decreases. The combined in vivo neutron activation-dual energy x-ray absorptiometry technique has allowed for the first time measurements in ward patients with Crohn's disease. The measurements confirm that TEE is not raised and that 30 to 35 kcal/kg per day is sufficient to achieve energy balance in such patients.

Resting and total energy expenditure in patients with inflammatory bowel disease

Patients with inflammatory bowel disease often present with weight loss. Among possible causes, an elevated energy expenditure has frequently been suggested but is the least documented. In this study resting metabolic rate (RMR) and total daily energy expenditure (TDEE) were measured in 15 outpatients with inflammatory bowel diseases and in eight healthy control subjects. Measured RMR as a percentage of that predicted from fat-free mass was not significantly different for control subjects (102 +/- 9.8%, mean +/- SD) and patients (100 +/- 13.3%). TDEE, expressed as a multiple of RMR, was 1.70 +/- 0.31 for control subjects and 1.78 +/- 0.24 for patients. When patients were subgrouped as greater than or equal to 90% or less than 90% desirable body weight, a mean increase over RMR predicted from fat-free mass was seen in the underweight patients (106 +/- 9.3%) but not in normal-weight patients (99.0 +/- 15.6%). Mean TDEE/RMR values for the patient subgroups were 1.70 +/- 0.30 and 1.88 +/- 0.08, respectively. We conclude that stable outpatients with inflammatory bowel disease have only a minimal increase in energy needs.