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Objective: To compare the differences to determine resting energy expenditure (REE) measured with indirect calorimetry and REE predicted by formula method and body composition analyzer in patients with decompensated hepatitis B cirrhosis, so as to provide theoretical guidance for the implementation of precision nutrition intervention. Methods: Patients with decompensated hepatitis B cirrhosis who were admitted to Henan Provincial People's Hospital from April 2020 to December 2020 were collected. REE was determined by the body composition analyzer and the H-B formula method. Results: were analyzed and compared to REE measured by the metabolic cart. Results A total of 57 cases with liver cirrhosis were included in this study. Among them, 42 were male, aged (47.93 ± 8.62) years, and 15 were female aged (57.20 ± 11.34) years. REE measured value in males was (1 808.14 ± 201.47) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.002 and 0.003, respectively). REE measured value in females was (1 496.60 ± 131.28) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.016 and 0.004, respectively). REE measured with the metabolic cart had correlation with age and area of visceral fat in men (P = 0.021) and women (P = 0.037). Conclusion: Metabolic cart use will be more accurate to obtain resting energy expenditure in patients with decompensated hepatitis B cirrhosis. Body composition analyzer and formula method may underestimate REE predictions. Simultaneously, it is suggested that the effect of age on REE in H-B formula should be fully considered for male patients, while the area of visceral fat may have a certain impact on the interpretation of REE in female patients.
Subject(s)
Humans , Male , Female , Energy Metabolism , Liver Cirrhosis/metabolism , Calorimetry, Indirect/methods , HospitalizationABSTRACT
Objective To investigate the value of resting energy expenditure (REE) monitoring in nutritional support therapy of critical patients on mechanical ventilation.Methods A prospective randomized controlled trial was conducted.Sixty critical patients [acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ) ＞ 15] on ventilation admitted to intensive care unit (ICU) of Dalian Friendship Hospital from September 2016 to October 2018 were enrolled.The enrolled patients were randomly divided into Harris-Benedict formula (HB formula) group and indirect energy measurement (metabolic vehicle) group with 30 patients in each group.The HB formula group was used traditional HB formula to determine the energy supply and ratio of nutritional support therapy,and the metabolic vehicle group was regularly measured the energy supply and proportion of nutritional support therapy.Serum albumin (ALB),total protein (TP),lymphocyte ratio,blood glucose,blood gas analysis parameters and REE value were determined at 3,5,7,9,and 11 days of nutritional support therapy.Results The value of REE at 3 days of nutritional support therapy in metabolic vehicle group was significantly higher than that in HB formula group (kJ/d:7 850.4±947.3 vs.6 915.3±875.7,P ＜ 0.05).With the time of nutritional support treatment prolonged,the REE value of metabolic vehicle group was decreased gradually,and after 7 days,the patient's condition was stable and improved,and the REE value tended to be stable gradually,it was significantly lower than that of HB formula group at 11 days (kJ/d:5 046.3 ± 493.3 vs.6 915.3 ± 875.7,P ＜ 0.05).There was no significant difference in blood gas analysis or plasma protein before nutritional support therapy between the two groups.After 5 days of nutritional support therapy,the respiratory function of critical patients in both groups was improved,and the lymphocyte ratio and plasma protein parameters were alleviated.After 11 days of nutrition support therapy,the respiratory function of critical patients in both groups was further improved,the ventilator model was adjusted to continuous positive airway pressure (CPAP) mode,the lymphocyte ratio and plasma protein parameters were improved,and the skin color and elasticity were improved,the granulation of the wound was fresh and healed well,and the plasma protein level was increased obviously,ALB level in metabolic vehicle group was significantly higher than that in HB formula group (g/L:31.8 ± 2.5 vs.26.7 ± 2.3,P ＜ 0.05).In the metabolic vehicle group,REE value was decreased from the maximum level on the 3rd day (k J/d:7 850.4 ± 947.3) to a stable level after 11 days (k J/d:5 046.3 ± 493.3),and its energy ratio changed significantly,from carbohydrate:fat of 77％ ∶ 21％ with protein consumption gradually transition in the early (3 days) to carbohydrates:fat of 56％ ∶ 44％ without protein consumption in the later stage (11 days),which showed the tendency of energy consumption was reasonable.Conclusion The energy metabolism rule of critical patients on ventilation could be determined by using the accurate metabolic vehicle and dynamic monitoring of REE value,which could be used for the implementation of nutritional support therapy.
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Objective To investigate the changing laws of rest energy expenditure (REE) in intensive care unit (ICU) patients and the intervention effect for nutritional support. Methods A prospective randomized control trial was conducted. Fifty-eight critically ill patients who were expected to be able to receive sustained enteral and (or) parenteral nutrition for more than 7 days admitted to ICU of the First Affiliated Hospital of Bengbu Medical College from December 2016 to June 2017 were enrolled. The patients were divided into REE group (n = 29) and HBREE group (n = 29) according to the random number table. On the 1st to 7th day after ICU admission, the indirect calorimetry and the Harris-Benedict (HB) formula were used to obtain the REE and HBREE values, and nutritional support was given according to REE and HBREE values respectively. The data of hemoglobin (Hb), albumin (Alb), prealbumin (PA), C-reactive protein (CRP), oxygenation index (OI) on 1st, 3rd, 5th, 7th and discharged day, and insulin dosage, vasopressor time, mechanical ventilation time, the length of ICU stay, and 28-day mortality were collected. Results ① At the beginning, the REE level was high, and then decreased gradually with the extension of hospitalization, and the decline was obvious on the 2nd to 3rd day (kJ/d: 7088.38±559.41, 6751.34±558.72 vs. 7553.44±645.55, both P < 0.05), and was stable from the 5th day, the changing laws showed high at first, then the low, the first rapid decline, then the slow decline, and then reached the steady, there was a 2-day plateau in the middle. During the first 2 days, the REE value was significantly higher than the HBREE value (kJ/d: 7553.44±645.55 vs. 6759.21±668.14, 7088.38± 559.41 vs. 6759.21±668.14, both P < 0.01); on the 3rd, 4th day, the REE value was almost the same as the HBREE value (kJ/d: 6751.34±558.72 vs. 6759.21±668.14, 6568.03±760.19 vs. 6759.21±668.14, both P > 0.05). After that, the REE value was significantly lower than the HBREE value (kJ/d: 6089.55±560.70 vs. 6759.21±668.14, 5992.55±501.82 vs. 6759.21±668.14, 5860.84±577.59 vs. 6759.21±668.14, all P < 0.01). ② After the initiation of nutritional support, Hb in the REE group (the first 3 days) and HBREE group (the first 7 days) all increased slowly in the early stage. It increased obviously on the 5th day in the REE group. Compared with the REE group, Hb increased more slowly in the HBREE group, however, there was no difference between the two groups at the time of discharge (g/L: 113.75±17.28 vs. 110.86±15.35, P > 0.05). PA and OI all enhanced significantly on the 3rd day since the nutritional support was initiated, but the daily increase of the REE group was significantly higher than that of the HBREE group [3rd day, PA (mg/L): 110.38±27.65 vs. 96.28±18.06, OI (mmHg, 1 mmHg = 0.133 kPa): 259.29±49.36 vs. 231.74±28.02, both P < 0.05]. The Alb and CRP in the REE group began to improve on the 3rd day, while the index in the HBREE group was delayed on the 5th day, overall, at the time of discharge, the PA, CRP and OI were lower in the HBREE group than in the REE group [PA (mg/L): 252.28±56.94 vs. 295.86±57.26, CRP (mg/L): 73.14±17.63 vs. 56.52±14.91, OI (mmHg): 353.59±70.36 vs. 417.52±71.58, all P < 0.01]. ③ The vasopressor was used in both groups for less than 3 days, but the REE group was shorter (days: 2.26±0.82 vs. 2.95±1.22, P < 0.05), the insulin dosage in the HBREE group was much more than that in the REE group (U: 101.97±21.05 vs. 84.59±22.21, P <0.01); compared with the REE group, the time of mechanical ventilation and the length of ICU stay in the HBREE group were longer (hours: 113.07±25.96 vs. 93.41±27.25, days: 10.41±3.11 vs. 8.45±2.44, both P < 0.01). There was no significant difference in the 28-day mortality between the REE group and HBREE group (17.24％ vs. 24.14％, P >0.05). Conclusions Indirect calorimetry can more accurately grasp the changing laws of REE in critically ill patients. Nutritional support with REE value can make relevant nutritional indicators as good as possible, and reduce insulin dosage, shorten vasopressor use time, the length of ICU stay and mechanical ventilation time, but does not change the 28-day mortality.
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Objective@#To investigate the changing laws of rest energy expenditure (REE) in intensive care unit (ICU) patients and the intervention effect for nutritional support.@*Methods@#A prospective randomized control trial was conducted. Fifty-eight critically ill patients who were expected to be able to receive sustained enteral and (or) parenteral nutrition for more than 7 days admitted to ICU of the First Affiliated Hospital of Bengbu Medical College from December 2016 to June 2017 were enrolled. The patients were divided into REE group (n = 29) and HBREE group (n = 29) according to the random number table. On the 1st to 7th day after ICU admission, the indirect calorimetry and the Harris-Benedict (HB) formula were used to obtain the REE and HBREE values, and nutritional support was given according to REE and HBREE values respectively. The data of hemoglobin (Hb), albumin (Alb), prealbumin (PA), C-reactive protein (CRP), oxygenation index (OI) on 1st, 3rd, 5th, 7th and discharged day, and insulin dosage, vasopressor time, mechanical ventilation time, the length of ICU stay, and 28-day mortality were collected.@*Results@#① At the beginning, the REE level was high, and then decreased gradually with the extension of hospitalization, and the decline was obvious on the 2nd to 3rd day (kJ/d: 7 088.38±559.41, 6 751.34±558.72 vs. 7 553.44±645.55, both P < 0.05), and was stable from the 5th day, the changing laws showed high at first, then the low, the first rapid decline, then the slow decline, and then reached the steady, there was a 2-day plateau in the middle. During the first 2 days, the REE value was significantly higher than the HBREE value (kJ/d: 7 553.44±645.55 vs. 6759.21±668.14, 7 088.38±559.41 vs. 6 759.21±668.14, both P < 0.01); on the 3rd, 4th day, the REE value was almost the same as the HBREE value (kJ/d: 6 751.34±558.72 vs. 6 759.21±668.14, 6 568.03±760.19 vs. 6 759.21±668.14, both P > 0.05). After that, the REE value was significantly lower than the HBREE value (kJ/d: 6 089.55±560.70 vs. 6 759.21±668.14, 5 992.55±501.82 vs. 6 759.21±668.14, 5 860.84±577.59 vs. 6 759.21±668.14, all P < 0.01). ② After the initiation of nutritional support, Hb in the REE group (the first 3 days) and HBREE group (the first 7 days) all increased slowly in the early stage. It increased obviously on the 5th day in the REE group. Compared with the REE group, Hb increased more slowly in the HBREE group, however, there was no difference between the two groups at the time of discharge (g/L: 113.75±17.28 vs. 110.86±15.35, P > 0.05). PA and OI all enhanced significantly on the 3rd day since the nutritional support was initiated, but the daily increase of the REE group was significantly higher than that of the HBREE group [3rd day, PA (mg/L): 110.38±27.65 vs. 96.28±18.06, OI (mmHg, 1 mmHg = 0.133 kPa): 259.29±49.36 vs. 231.74±28.02, both P < 0.05]. The Alb and CRP in the REE group began to improve on the 3rd day, while the index in the HBREE group was delayed on the 5th day, overall, at the time of discharge, the PA, CRP and OI were lower in the HBREE group than in the REE group [PA (mg/L): 252.28±56.94 vs. 295.86±57.26, CRP (mg/L): 73.14±17.63 vs. 56.52±14.91, OI (mmHg): 353.59±70.36 vs. 417.52±71.58, all P < 0.01]. ③ The vasopressor was used in both groups for less than 3 days, but the REE group was shorter (days: 2.26±0.82 vs. 2.95±1.22, P < 0.05), the insulin dosage in the HBREE group was much more than that in the REE group (U: 101.97±21.05 vs. 84.59±22.21, P < 0.01); compared with the REE group, the time of mechanical ventilation and the length of ICU stay in the HBREE group were longer (hours: 113.07±25.96 vs. 93.41±27.25, days: 10.41±3.11 vs. 8.45±2.44, both P < 0.01). There was no significant difference in the 28-day mortality between the REE group and HBREE group (17.24% vs. 24.14%, P > 0.05).@*Conclusions@#Indirect calorimetry can more accurately grasp the changing laws of REE in critically ill patients. Nutritional support with REE value can make relevant nutritional indicators as good as possible, and reduce insulin dosage, shorten vasopressor use time, the length of ICU stay and mechanical ventilation time, but does not change the 28-day mortality.
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Objective To compare differences among measured rest energy expenditure (REE) by using indirect calorimetry (IC) and predictive REE from predictive equations (PE) and human body component analyzer (HBCA).Methods Young and middle-aged healthy volunteers of light manual labor were recruited in this study.REEs were obtained from IC,PE (WHO-Schofield and Harris-Benedict equations) and HBCA.Results A total of 30 healthy participants were included,of whom 12 were males (25-46 years old) with an average age of (37.8±7.4) and 18 were females (26-52 years old) with an average age of (40.4±7.8).Measured REE of the males was (1 848.33± 155.01) kcal/d,which was significantly different from the predictive REE result of H-B equation (P=0.003) but not from results of WHO-Schofield equation and HBCA.In females,however,measured REE was (1 294.44± 134.23) kcal/d,which was significantly different from predictive REE results of both equations and HBCA,P=0.002 (WHO-Schofield),P=0.031 (H-B) and P=0.002 (HBCA).Results of measured REE were related to weight (P=0.033) and percentage of body fat (P=0.036) in males,and to height and muscle mass (P=0.003) in females.Conclusion In young and middle-aged healthy females of light manual labor,IC represented a more accurate way to measure REE,while in males WHO-Schofield equation and HBCA could be considered as alternative choices to predict REE.
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PURPOSE: To predict the energy expenditure using the stress factor representing the ratio of the metabolic variation between pre-operation and post-operation in a pancreaticoduodenectomy (PD). METHODS: This was a prospective study conducted on 17 patients (11 males and 6 females) who underwent PD at Chonbuk National University Hospital between March 2010 and October 2011. The rest energy expenditure was measured by indirect calorimetry 1 day before and 3 days after surgery. The height, weight, and fat free mass were also measured 1 day before surgery. RESULTS: The mean measured rest energy expenditure 1 day before PD (mREEpre) and 3 days after PD (mREEpost) were significantly different (16.8±2.6 vs. 18.8±3.5 kcal/kg/d, P=0.0076). The stress factor, representing the ratio of the metabolic changes between pre- and post-PD, was 1.12±0.17. The recommended energy requirement for PD patients is estimated to be 23∼24 kcal/ideal body weight/d [determined from the measured preoperative rest energy expenditure (16.8±2.6 kcal/kg/d)×activity factor (1.2∼1.3)×stress factor (1.12)]. CONCLUSION: PD patients maintained a hypermetabolic status and the applicable stress factor was 1.12.
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Humans , Male , Calorimetry, Indirect , Energy Metabolism , Pancreaticoduodenectomy , Prospective StudiesABSTRACT
Objective To observe the impact of the diverse caloric energy intake on the outcomes and occurrence rate of complications in septic patients.Methods A prospective single-blind randomized controlled trial was conducted.158 cases of septic patients in intensive care unit (ICU) were enrolled and randomly assigned to three groups according to their different target value of nutrition:group A [measurements of resting energy expenditure (MREE)＜90％],B (MREE 90％-110％) and C (MREE ＞ 110％).The caloric intake,mechanical ventilation duration (MVD),nosocomial infection rate,28-day and 60-day mortality were analyzed.Results Daily energy intake in 7 days after ICU admission was as follows:the difference in target value of nutrition(kJ/d:7 075.0 ± 1 046.5,5 667.8 ± 1 908.8,4 428.8 ± 1 377.8),calory intake (kJ/d:4 671.6 ± 1 205.6,5 655.3 ± 1 373.0,6 053.0 ± 1 557.2),enteral nutrition value (kJ/d:2 051.1 ± 1 046.5,3 980.9 ± 1 586.5,5 337.1 ±2 921.8) and average intake rate [(66.0 ± 15.8)％,(100.0 ± 5.7)％,(134.0 ± 19.7)％],and they were statistically significant difference among A,B,C groups (all P＜0.05).The parenteral nutrition in group C were much higher than that in group A and group B (kJ/d:2 055.3 ± 273.4vs.427.0 ± 273.4,473.0 ± 332.0,both P＜0.05).The calories provided by glucose and diprivan were similar among three groups.The MVD and ICU stay were shorter in group B than that in groups A and C [MVD (days):8.4 ± 6.3 vs.11.0 ± 8.2,17.8 ± 13.0,P＞ 0.05 and P＜ 0.05 ; ICU stay (days):11.0 ± 6.4 vs.14.9 ± 9.6,17.8 ± 13.0,respectively,P＞0.05 and P＜0.05].The total hospital stay (days:32.0 ± 22.5,26.8 ± 7.0,30.4 ± 21.4) and nosocomial infection rate [91.1％ (51/56),84.0％ (42/50),90.4％ (47/52)] were similar among A,B,C groups (all P＞0.05).There was no difference in survival rate at 28 days among three groups as shown by the Kaplan-Meier survival curve (F=3.145,P=0.076).The survival rate at 60 days showed a tendency of lowering in groups A and C,especially in group C (F=9.284,P=0.010).Conclusion Both higher and lower caloric energy intake may be associated with an adverse impact,but appropriate caloric intake would improve the outcome and reduce the complication rate in septic patients.
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This study investigated and compared the daily activities and energy expenditure of normally-weighted and obese elementary school children. The participants were 115 boys and 115 girls (6th grade) at ten elementary schools in Busan. Time spent on each activity was evaluated using the twenty-four hour recall method. 1) The general characteristics of the normally-weighted and obese children did not differ, although the normally-weighted children exercised and used stairs more than the obese children.2) Among their classified activities, the children spent most of their time resting, study, leisure, physiology and hygiene, commuting, and housework in that decreasing order. Normally-weighted children spent less time tying down and in conversation with family and friends than obese ones. 3) The children's average activity factors were 1.47 - 1.50. The normally-weighted children's rest energy expenditure (REE) (1391.4 kcal,1264.7 kcal) was less than that of the obese children (1711.4 kcal. 1461.0 kcal) . The normally-weighted children's daily energy expenditure was less than that of the obese, but energy expenditure per body weight was less in obese children than in the normally-weighted. In conclusion, sedentary activities and energy expenditure per body weight was less in the obese compared to the normally-weighted children. Programs to help children perceive and practice desirable physical activities should be suggested for prevention of obesity in children.