Comparison of three different measurement methods to determine resting energy expenditure in patients with decompensated hepatitis B cirrhosis / 中华肝脏病杂志

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.

Energy expenditure, growth, and nutritional therapy in appropriate and small for gestational age preterm infants / Gasto energético, crescimento e terapia nutricional em recém-nascidos pré-termo adequados e pequenos para idade gestacional

Abstract Objective: To evaluate the resting energy expenditure, growth, and quantity of energy and macronutrients intake in a group of preterm newborns. Methods: The cohort study was performed with appropriate and small for gestational age preterm infants (birth weight lower than 1500 g or gestational age < 32 weeks). Resting energy expenditure was measured using indirect calorimetry on the 7th, 14th, 21st, and 28th days of life, and at discharge. Length, head circumference and body weight were assessed weekly. Nutritional therapy was calculated during the hospital stay and the information for each type of food was recorded in software that calculates the total amount of energy and macronutrients. Results: 61 preterm infants were followed; 43 appropriate and 18 small for gestational age infants. There was no statistical difference for resting energy expenditure between the groups, and it increased from the first to the fourth week of life (appropriate: 26.3% and small: 21.8%). Energy intake in the first two weeks of life was well below the energy requirement. Conclusion: Considering that the results demonstrate high energy expenditure during the first weeks of life, there is an evident need to provide the best quality of nutrition for each child in the first weeks of life so that preterm infants with or without intrauterine growth restriction can achieve their maximum potential for growth and development.

Resumo Objetivo: Avaliar o gasto energético de repouso, o crescimento e a quantidade ofertada de energia e macronutrientes em um grupo de recém-nascidos pré-termo. Método: Foi feito estudo de coorte com recém-nascidos pré-termo adequados e pequenos para a idade gestacional (peso de nascimento inferior a 1.500 gramas ou idade gestacional < 32 semanas). O gasto energético foi avaliado com a calorimetria indireta nos dias 7°, 14°, 21°, 28° dias de vida e alta hospitalar. Medidas do comprimento, perímetro cefálico e peso corporal foram avaliadas semanalmente. A terapia nutricional foi calculada durante a internação do recém-nascido e as informações de cada tipo de alimentação foram registradas em um software que calcula a quantidade total de energia e macronutrientes. Resultados: Foram acompanhados 61 recém-nascidos, sendo 43 adequados e 18 pequenos para idade gestacional. O gasto energético de repouso não apresentou diferença estatística entre os grupos e aumentou entre a primeira e quarta semana de vida (adequados: 26,3% e pequenos: 21,8%). O aporte energético nas duas primeiras semanas de vida mostrou-se bem abaixo do requerimento energético mensurado pela calorimetria. Conclusão: Considerando os resultados que demonstram um gasto energético alto ao longo das primeiras semanas de vida, fica evidente a necessidade de fornecer ao recém-nascido pré-termo um melhor aporte energético já nas primeiras semanas de vida, para que os neonatos com ou sem restrição intrauterina possam atingir o seu potencial máximo de crescimento e desenvolvimento.

Applicability of predictive equations for resting energy expenditure in obese patients with obstructive sleep apnea

ABSTRACT Objective To investigate the applicability of predictive equations for resting energy expenditure (REE) in obese individuals with obstructive sleep apnea (OSA) and the effects of OSA severity on REE. Materials and methods Twenty-nine obese men, 41.5 ± 7 years old, with moderate and severe OSA were recruited. All subjects were submitted to a clinical polysomnography, body composition, and indirect calorimetry measurements. REE was also predicted by three different equations: Harris and Benedict (1919), Cunningham (1990), and DRI (2002). Results No effects of OSA severity on REE were found. The measured REE (2416.0 ± 447.1 kcal/day) and the REE predicted by equations were different from each other (F = 2713.88; p < 0.05): Harris and Benedict (2128.0 ± 245.8 kcal/day), Cunningham (1789.1 ± 167.8 kcal/day) and DRI (2011.1 ± 181.4 kcal/day). Pearson correlations showed a moderate positive correlation between the REE measured and predicted by all equations. Conclusion Our findings suggest that predictive equations for REE underestimate the energy expenditure in obese patients with sleep apnea. Also, no effects of OSA severity on REE were found.

Which equation should be used to measure energy expenditure in HIV-infected patients? / Qual equação utilizar para avaliar gasto energético de portadores do HIV?

OBJECTIVE: In view of the practical need to use equations for the evaluation of energy expenditure in HIV-infected patients, the objective of the present study was to determine the concordance between the energy expenditure values obtained by indirect calorimetry as the gold standard and those obtained by predictive equations elaborated from data for the healthy population: Harris-Benedict, Schofield and Cunningham, and by equations elaborated from data for HIV-infected patients: Melchior (1991-1993). METHODS: The study was conducted at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto on 32 HIV-infected men under treatment with highly active antiretroviral therapy. Resting energy expenditure was measured by indirect calorimetry and estimated on the basis of measurement of O2 consumption and CO2 production. RESULTS: Statistical analysis revealed weak concordance for the Harris-Benedict (0.38) and Cunningham (0.34) equations and satisfactory concordance for the Schofield equation (0.47). Only the two Melchior equations (1991 and 1993) showed strong concordance with the values obtained by indirect calorimetry (0.63 and 0.66, respectively) and could be used in practice. CONCLUSION: The best equations seem to be population-specific, such as the Melchior equations elaborated for HIV-infected patients.

OBJETIVO: Frente à necessidade prática da utilização de equações para avaliar gasto energético em portadores do HIV, o presente estudo avaliou a concordância dos valores de gasto energético obtidos pelo padrão ouro de calorimetria indireta com equações preditivas desenvolvidas a partir de população saudável: Harris-Benedict, Schofield e Cunningham e equações desenvolvidas a partir de portadores do HIV: Melchior (1991 a 1993). MÉTODOS: O estudo foi realizado no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, com 32 homens portadores do HIV em terapia antirretroviral de alta potência. O gasto energético de repouso foi medido por calometria indireta e estimado a partir de medida de consumo de O2 e produção de CO2. RESULTADOS: De acordo com análise estatística, a concordância foi fraca para equações de Harris-Benedict (0,38) e Cunningham (0,34) e satisfatória para Schofield (0,47). Apenas as duas equações de Melchior apresentaram forte concordância com valores obtidos por calometria indireta (respectivamente 0,63 e 0,66) e poderiam ser utilizadas na prática. CONCLUSÃO:: As melhores equações parecem ser população específica, como as de Melchior, desenvolvidas para portadores do HIV.

Balanço energético em crianças e adolescentes com bronquiolite obliterante pós-infecciosa / Energy balance in children and adolescents with post-infectious bronchiolitis obliterans

OBJETIVOS: Quantificar o gasto e estimar a ingestão energética de crianças e adolescentes com bronquiolite obliterante pós-infecciosa e comparar com crianças e adolescentes hígidos. MÉTODOS: Estudo transversal com 72 crianças e adolescentes de 8 a 18 anos. Compararam-se dois grupos de 36 indivíduos - um com diagnóstico de bronquiolite obliterante e outro hígido -, os quais foram pareados pelo sexo, idade e classificação do índice de massa corporal. Para avaliação nutricional, utilizaram-se a antropometria e a composição corporal. O gasto energético foi medido pela calorimetria indireta; o fator atividade, pelo recordatório 24h de atividades físicas, e a ingestão energética, pelos inquéritos alimentares. RESULTADOS: O grupo com bronquiolite obliterante e o grupo-controle apresentaram respectivamente: índice de massa corporal de M=18,9, DP=4,0kg/m² e M=18,8, DP=3,4kg/m²; gasto energético de repouso de M=1717,6, DP=781,5 e M=2019,9, DP=819; gasto energético total de M=2677,5, DP=1514,0kcal/dia e M=3396,1, DP=1557,9kcal/dia; estimativa da ingestão energética de M=2294,1, DP=746,7kcal/dia e M=2116,5, DP=612,1kcal/dia. O gasto energético de repouso (p=0,102) e o gasto energético total (p=0,051) não foram diferentes entre os grupos, mesmo quando ajustados pela massa magra. Não houve diferenças estatisticamente significativas entre o o gasto energético total e o consumo energético no grupo com bronquiolite obliterante (p=0,202). O grupo-controle consumiu menos calorias do que o previsto pelo gasto energético total (p<0,001). CONCLUSÃO: O gasto energético de repouso e o gasto energético total foram semelhantes entre os grupos. A estimativa da ingestão energética dos hígidos foi menor que o gasto energético total. O grupo com bronquiolite obliterante apresentava um balanço energético adequado.

OBJECTIVE: The aim of the study was to determine the energy expenditure and estimate the energy intake of children and adolescents with post-infectious bronchiolitis obliterans and compare them with those of healthy children and adolescents. METHODS: This cross-sectional study included 36 children and adolescents with bronchiolitis obliterans aged 8 to 18 years, and a control group with 36 healthy individuals matched for sex, age and body mass index. Anthropometric data were collected from all individuals. Energy expenditure was determined by indirect calorimetry, activity factor was estimated by a 24-hour record of physical activities, and energy intake was estimated by the 24-hour food recall. RESULTS: Data for the bronchiolitis obliterans and control groups are, respectively: body mass index of M=18.9, SD=4.0kg/m² and M=18.8, SD=3.4kg/m²; resting energy expenditure of M=1717.6, SD=781.5kcal/day and M=2019.9, SD=819kcal/day; total energy expenditure of M=2677.5, SD=1514.0kcal/day and M=3396.1, SD=1557.9kcal/day; estimated energy intake of M=2294.1, SD=746.7kcal/day and M=2116.5, SD=612.1kcal/day. Resting energy expenditure (p=0.102) and total energy expenditure (p=0.051) did not differ between the groups, even when adjusted for lean mass. Total energy expenditure and intake of the bronchiolitis obliterans group did not differ significantly (p=0.202). Energy intake by the control group was lower than expected according to their total energy expenditure (p<0.001). CONCLUSION: The resting energy expenditure and total energy expenditure of the two groups were similar. The estimated energy intake of the control group was lower than their total energy expenditure. The bronchiolitis obliterans group had an appropriate energy balance.

Energy expenditure in critically ill surgical patients. Comparative analysis of predictive equation and indirect calorimetry / Gasto energético em pacientes cirúrgicos. Análise comparativa entre equação preditiva e calorimetria indireta

PURPOSE: The aim of this investigation was to compare the resting energy expenditure (REE) calculated by the Harris-Benedict equation (REE HB) with the REE measured by indirect calorimetry (REE IC) in critically ill surgical patients under mechanical ventilation. METHODS: Thirty patients were included in this work. REE was calculated by the Harris-Benedict equation (REE HB) using real body weight, and it was also measured by indirect calorimetry (REE IC), which was performed for 30 minutes. RESULTS: REE HB had significant (p < 0.0005) but low correlation (Spearman r = 0.57) with REE IC, with a mean bias of 12 kcal.d-1 and limits of agreement ranging from - 599.7 to 623.7 kcal.d-1 as detected by the Bland-Altman analysis. CONCLUSION: These findings suggest that REE IC seems to be more appropriate than REE HB for accurate measurement of REE in critically ill surgical patients under mechanical ventilation.

OBJETIVO: O objetivo deste estudo foi comparar o gasto energético de repouso (GER), calculado pela equação de Harris-Benedict (GER HB) com o GER medido pela calorimetria indireta (GER CI) em pacientes cirúrgicos gravemente enfermos em ventilação mecânica. MÉTODOS: Trinta pacientes foram incluídos nesta investigação. O gasto energético de repouso foi calculado pela equação de Harris-Benedict (GER HB) utilizando o peso corporal real e medido pela calorimetria indireta (GER CI). A calorimetria indireta foi realizada durante 30 minutos. RESULTADOS: O gasto energético de repouso calculado pela equação de Harris-Benedict mostrou uma correlação significativa (p < 0,0005), porém fraca (Spearman r = 0,57) com GER CI, com um viés médio de 12 kcal.d-1 e os limites de concordância variando de - 599,7 a -623,7 kcal.d-1 como detectados pela análise de Bland-Altman. CONCLUSÃO: Estes achados sugerem que a calorimetria indireta parece ser mais apropriada do que a equação de Harris Benedict para a medida exata do GER em pacientes cirúrgicos gravemente enfermos em ventilação mecânica.

Precisão da medida do limiar anaeróbio por meio do calorímetro portátil / Measurement precision of the anaerobic threshold by means of a portable calorimeter / Precisión de la medición del umbral anaerobio por medio del calorímetro portátil

FUNDAMENTO: Muitos métodos são empregados para determinar o Limiar Anaeróbio (LAn) por meio de ergoespirômetros sofisticados. OBJETIVO: Testar a variação no LAn, detectado por modelos matemáticos e de inspeção visual, quando empregado ergoespirômetro de baixo custo e destinado à aplicação clínica. MÉTODOS: Foram voluntários para esse estudo 79 indivíduos aparentemente saudáveis; desses, 57 homens. O VO2máx e o limiar ventilatório foram determinados por calorimetria indireta de circuito aberto. O método eletroenzimático foi empregado para análise da lactacidemia e determinação direta do limiar de lactato (LL). O LAn foi determinado por dois métodos matemáticos (MM SQR e MMslope), baseados nas trocas gasosas, e pelo método de inspeção visual do log-log, para determinação do LL. Dois pesquisadores independentes determinaram o LAn através da inspeção visual de três gráficos, considerando dois métodos (LAn-a= V-slope, EqV; e LAn-b = V-slope, EqV e ExCO2). Os dados foram analisados por meio da estatística paramétrica para determinação das diferenças entre LAn-a versus ExCO2, MM SQR e MMslope; LAn-b versus MM SQR e MMslope; e LL versus LAn-a, LAN-b, MM SQR e MMslope. RESULTADOS: O MMslope foi o único método que apresentou diferença significativa entre o LAn-a e LAn-b (p=0,001), com CV por cento >15. O LL versus MMslope não apresentou diferença significativa (p=0,274), contudo, observou-se um elevado CV (24 por cento). CONCLUSÃO: Conclui-se que com o equipamento de baixo custo os métodos MM SQR e LAn-a podem ser utilizados para a determinação do LAn. O método MMslope não apresentou precisão satisfatória para ser empregado com esses equipamentos.

BACKGROUND: Many methods are used for determining the Anaerobic Threshold (AT) by means of sophisticated ergospirometer. OBJECTIVE: To test the AT variation, detected by mathematical models and visual inspection, when low cost ergospirometer is used and intended for clinical application. METHODS: Seventy nine apparently healthy subjects were volunteers in this study; from these, 57 men. The VO2max and the ventilatory threshold were determined by indirect, open-circuit calorimetry. The electro-enzymatic method was used for analyzing the lactacidemia and direct determination of the Lactate Threshold (LT). The AT was determined by two mathematical methods (MM RSS and MMslope), based on the gases exchange, and by the log-log visual method, for determining the LT. Two independent investigators determined the AT through visual inspection of three graphs, considering two methods (AT-a= V-slope, EqV; and AT-b = V-slope, EqV and ExCO2). The data were analyzed by means of parametric statistics for determining the differences between AT-a versus ExCO2, MM RSS and MMslope; AT-b versus MM RSS and MMslope; and LT versus AT-a, AT-b, MM RSS and MMslope. RESULTS: The MMslope was the only method that presented a significant difference between the AT-a and AT-b (p=0.001), with CV percent >15. LT versus MMslope did not present significant difference (p=0.274), however, it was observed a high CV (24 percent). CONCLUSION: It was concluded that with the low cost equipment, the MM RSS and AT-a methods can be used for determining the TAn. The MMslope method did not present satisfactory precision to be employed with this equipment.

FUNDAMENTO: Muchos métodos se emplean para que se determine el Umbral Anaerobio (UAn) por medio de ergoespirómetros sofisticados. OBJETIVO: Probar la variación en el UAn, detectado por modelos matemáticos y de inspección visual, cuando empleado ergoespirómetro de bajo costo y destinado a la aplicación clínica. MÉTODOS: Fueron voluntarios para este estudio 79 individuos aparentemente sanos; de ellos, 57 varones. El VO2máx y el umbral ventilatorio se determinaron por calorimetría indirecta de circuito abierto. El método electroenzimático se empleó para análisis de lactacidemia y determinación directa del umbral de lactato (UL). El UAn fue determinado por dos métodos matemáticos (MM SQR y MMslope), basados en los cambios gaseosos, y por el método de inspección visual del log-log, para determinación del UL. Dos investigadores independientes determinaron el UAn a través de la inspección visual de tres gráficos, teniendo en cuenta dos métodos (UAn-a= V-slope, EqV; y UAn-b = V-slope, EqV y ExCO2). Los datos se analizaron por medio de la estadística paramétrica para determinación de las diferencias entre UAn-a versus ExCO2, MM SQR y MMslope; UAn-b versus MM SQR y MMslope; y UL versus UAn-a, UAN-b, MM SQR y MMslope. RESULTADOS: El MMslope fue el único método que presentó diferencia significativa entre el UAn-a y UAn-b (p=0,001), con CV por ciento >15. El UL versus MMslope no presentó diferencia significativa (p=0,274), con todo, se observó un elevado CV (24 por ciento). CONCLUSIÓN: Se concluyó que con el equipamiento de bajo costo los métodos MM SQR y UAn-a pueden utilizarse para la determinación del UAn. El método MMslope no presentó precisión satisfactoria para ser empleado con estos equipamientos.

Validação das equações que estimam a taxa metabólica de repouso em adolescentes meninas / Validation of the equations that estimate the resting metabolic rate in adolescent girls

OBJETIVOS: O objetivo deste estudo é analisar a validade das equações de predição da taxa metabólica de repouso (TMR) propostas por Harris e Benedicti (1919), Schofield (1985), WHO/FAO/UNU (1985), Henry e Rees (1991), Molnár e cols. (1995), Tverskaya e cols. (1998) e Müller e cols. (2004) em adolescentes meninas. SUJEITOS E MÉTODOS: Para tanto, avaliaram-se 51 meninas entre 10 e 17 anos, sendo mensuradas as seguintes variáveis: massa corporal, estatura, massa gorda (absoluta e percentual) e massa magra (absoluta e percentual), bem como os valores do consumo de VO2 e produção de VCO2 que foram substituídos na equação de Weir (1949) considerada, neste estudo, como método padrão da TMR. Realizaram-se os seguintes procedimentos estatísticos: teste "t" pareado (p < 0,05); erro constante (EC) com diferença menor que 5 por cento e análise gráfica de Bland e Altman (1986). RESULTADOS: As equações propostas por Tverskaya e cols. (1998) e Müller e cols. (2004) foram as únicas que apresentaram diferenças significativas entre as médias. No entanto, somente as equações propostas por Henry e Rees (1991) e Molnár e cols. (1995) obtiveram erro constante inferior a 5 por cento. Porém, as análises gráficas de Bland e Altman (1986) revelaram que, independentemente da equação, não há concordância entre as equações e o método padrão. CONCLUSÕES: O estudo indicou que as equações não aprovaram nos critérios estipulados e que, portanto, não possuem validade no cálculo da TMR.

OBJECTIVES: The objective of the study is to analyze the validity of the prediction equations for the resting metabolic rate (RMR) proposed by Harris and Benedicti (1919), Schofield (1985), WHO/FAO/ UNU (1985), Henry and Rees (1991), Molnár and cols. (1995), Tverskaya and cols. (1998) and Müller and cols. (2004) in adolescent girls (51 girls between 10 and 17 years of age). SUBJECTS AND METHODs: The following anthropometric variables were measured: body weight, stature, body fat mass (absolute and percentage), body lean mass (absolute and percentage) as well as the consumption ofVO2 and production ofVCO2 that were substituted in Weir's (1949) equation which was considered the RMR standard method in this study. The following statistical procedures were carried out: paired t-test (p < 0.05); constant error (CE) with a less than 5 percent difference and Bland and Altman's (1986) graphical analysis. RESULTS: The equations proposed by Tverskaya and cols. (1998) and Müller and cols. (2004) were the only equations that presented significant differences between the averages. However, only the equations proposed by Henry and Rees (1991) and Molnár and cols. (1995) produced a constant error of less than 5 percent. However, Bland and Altman's (1986) graphical analysis showed that independently of the equation there is no agreement between the equations and the standard method. CONCLUSIONS: The study indicates that none of the equations meet all the stipulated criteria and that thus have no validity in the calculation of the RMR.

Agreements between Indirect Calorimetry and Prediction Equations of Resting Energy Expenditure in End-Stage Renal Disease Patients on Continuous Ambulatory Peritoneal Dialysis

PURPOSE: Equations are frequently used to estimate resting energy expenditure (REE) in a clinical setting. However, few studies have examined their accuracy in end-stage renal disease (ESRD) patients. PATIENTS AND METHODS: To investigate agreement between indirect calorimetry and several REE estimating equations in 38 ESRD patients on peritoneal dialysis, we performed indirect calorimetry and compared the results with REEs estimated using 5 equations [Harris-Benedict (HBE), Mifflin, WHO, Schofield, and Cunningham]. RESULTS: Measured REE was 1393.2 +/- 238.7kcal/day. There were no significant differences between measured and estimated REEs except Mifflin (1264.9 +/- 224.8kcal/day). Root mean square errors were smallest for HBE, followed by Schofield, Cunningham, and WHO, and largest for Mifflin (171.3, 171.9, 174.6, 175.3, and 224.6, respectively). In Bland-Altman plot, correlation coefficients between mean values and differences were significant for HBE (r=0.412, p=0.012) and tended to be significant for Cunningham (r=0.283, p=0.086). In DM patients and patients with overhydration, HBE showed significant underestimation when REE increased. CONCLUSION: In ESRD patients on continuous ambulatory peritoneal dialysis (CAPD), REE-estimating equations have no significant differences from indirect calorimetry, except Mifflin. However, HBE showed greater bias than others when REE was high.

An easy way to estimate energy expenditure from hemodynamic data in septic patients / Um modo simples de estimar o consumo de energia a partir de dados hemodinâmicos em pacientes sépticos

PURPOSE: The purpose of this study is to compare the resting energy expenditure (REE) obtained by indirect calorimetry (IC) to the REE calculated by predictive equations (Brandi and Liggett) using the oxygen consumption (VO2) obtained by Fick's method in septic patients. METHODS: Prospective study in septic patients admitted in an intensive care unit of a university hospital. Fifteen adult patients (11 men and four women) were studied. VO2 measurements were made using a portable metabolic cart connected to a respirator and a pulmonary artery catheter. RESULTS: The APACHE II at admission was 22.6±7.2 with a mortality risk of 46.1±27.7 percent. The mean REE obtained by IC and by the Brandi and Liggett equations were 1699±271, 1815±355 and 1361±277 kcal.day-1 respectively. There were no statistically significant differences between the two methods, with the two means showing a difference of 8.7 percent. REE values were close for IC x BRANDI (r=0.80), but the IC x LIGGETT correlation was only 0.58. CONCLUSIONS: The results suggest that REE can be easily calculated by obtaining VO2 with the Swan-Ganz catheter and using the Brandi equation even for septic patients under mechanical ventilation.

OBJETIVO: O objetivo desse estudo foi o de comparar o consumo de oxigênio em repouso (COR) obtido por calorimetria indireta (CI) com valores do COR calculados por equações preditivas (Brandi e Ligget) que utilizam o consumo de oxigênio (VO2) obtido pelo método de Fick em pacientes sépticos. MÉTODOS. Estudo prospectivo em pacientes sépticos internados em unidade de terapia intensiva de um hospital universitário. Quinze pacientes adultos (onze homens e quatro mulheres). As medidas de VO2 foram realizadas usando um aparelho metabólico portátil conectado ao respirador e por cateter em artéria pulmonar. RESULTADOS: O índice APACHE II na admissão foi 22.6±7.2 com risco de mortalidade de 46.1±27.7 por cento. As médias do COR obtidas por CI e pelas equações de Brandi and Liggett foram, respectivamente, 1699±271, 1815±355 e 1361±277 kcal.day-1 Não se observaram diferenças estatisticamente significantes entre os dois métodos com as duas médias mostrando uma diferenças de 8.7 por cento. Os valores de COR Também foram próximo dos valores de CI x BRANDI (r=0.80), mas a correlação com CI x LIGGETT apenas 0.58. CONCLUSÕES: Os resultados sugerem que o COR pode ser facilmente calculado para obter-se o VO2 com o cateter de Swan-Ganz e pelo uso da equação de Brandi para pacientes sépticos em ventilação mecânica.

As equações de predição da taxa metabólica basal são apropriadas para adolescentes com sobrepeso e obesidade? / Are basal metabolic rate prediction equations appropriate for overweight and obese adolescents?

As equações de predição conhecidas podem apresentar valores de taxa metabólica basal (TMB) diferentes daqueles medidos por calorimetria indireta. Os objetivos deste estudo foram descrever a TMB, por meio de calorimetria indireta, em meninos com sobrepeso e obesidade, de 12 a 17 anos de idade, residentes em Porto Alegre, Brasil, e comparar o valor medido com os valores de TMB estimados por equações de predição. A TMB foi medida por calorimetria indireta, pela manhã, em 35 voluntários, sob condições padronizadas de jejum, repouso e ambiente. A média (± desvio-padrão) da TMB medida foi de 1.900,5 ± 248,8kcal em 24 horas. A estimativa da TMB por equações foi significativamente maior, em três das quatro equações (6,5 a 9,5 por cento), do que a TMB medida (p < 0,05). Os dados evidenciaram que as equações de predição não são adequadas para estimar a TMB nos meninos com sobrepeso e obesidade avaliados. O emprego dessas equações, na maioria dos casos, pode superestimar os requerimentos energéticos para meninos com características semelhantes.

Gasto energético de reposo medido en obesos y no obesos: comparación con la estimación por fórmulas y ecuaciones propuestas para población chilena / Measured and predicted resting energy expenditure in obese and non obese chilean subjects: a proposal of predictive equations for the chilean population

Background: The commonly used predictive equations to calculate resting energy expenditure (REE) can yield inaccurate results. Aim: To compare measured REE, with estimated REE in normal and obese adults. To develop specific predictive equations for our population. Patients and Methods: Eight hundred sixteen women aged 18 to 74 years old with a body mass index (BMI) between 18.5 and 69.7 kg/m2 and 441 men aged 18 to 71 years old with a BMI between 185 and 67.9 kg/m2 were studied. REE was measured by indirect calorimetry and fat free mass by tetrapolar bioimpedance. REE was also estimated using FAO/WHO (F/W) and Harris-Benedict (H/B) equations. Results: Measured REE in controls was 20.7 ñ 1.9 and 23.6 ñ 3.3 kcal/kg/day in women and men respectively. The figures for overweight women and men were 19.8 ñ 1.9 and 20.0 ñ 2 kcal/kg/day, for obese women and men were 18.3 ñ 1.7 and 19.0 ñ 1.8 kcal/kg/day and for morbidly obese women and men, were 16.9 ñ 1.8 and 16.1 ñ 1.7 kcal/kg/day. When REE was corrected for fat free mass, no differences between controls and different degrees of obesity, were observed. The difference between estimated and measured REE ranged from -420 to 617 kcal in women and from -400 to 900 kcal in men. The equations derived using data obtained in the present study, showed a better predictive accuracy. Conclusions: An important error was detected when REE was predicted using FAO/WHO or Harris Benedict equations, in Chilean obese subjects. Therefore these equations must be used with caution, local equations must be devised or resting energy expenditure must be measured by indirect calorimetry

Energy expenditure after 2- to 3-hour elective surgical operations

Energy expenditure was measured by indirect calorimetry in 17 adult patients (8 women and 9 men) before surgery, 4 hours immediately after surgery , and 24 hours late after surgery in patients undergoing elective surgery of small-to-medium scope. MATERIAL AND METHODS: The total duration of surgery ranged from 2 to 3 hours. Repeated measures were performed on the same patient, so that each patient was considered to be his/her own control. All patients received a 5 percent dextrose solution (2000 mL/day) throughout the postoperative period. RESULTS: Men showed a reduction in CO2 production during the immediately after surgery period (257 + or - 42 mL/min) compared to before surgery (306 + or - 48 mL/min) and late after surgery (301 + or - 45 mL/min); this reduction was not observed in women. Energy expenditure was also lower in men during immediately after surgery (6.6 kJ/min). None of the other measurements, including substrate oxidation, showed significant differences. CONCLUSION: Therefore, elective surgery itself cannot be considered an important trauma that would result in increased energy expenditure. According to this study, it is not necessary to prescribe an energy supply exceeding basal expenditure during the immediate after-surgery period. The present results suggest that the energy supply prescribed during the postoperative period after elective surgery of small-to-medium scope should not exceed 5-7 kJ/min, so the patient does not receive a carbohydrate overload from energy supplementation

Gasto energético de reposo medido versus gasto energético estimado por fórmula en niños obesos / Measured resting energy expenditure versus estimated energy expenditure by formulas in obese children

Con el objetivo de comparar el gasto energético estimado (GEE) por fórmulas de FAO/OMS (F/O), Fleisch (F) o Schofield (S), con el medido por calorimetría indirecta GEM, se estudió a 51 niñas y 27 niños entre 10 y 14 años con sobrepeso u obesidad. Resultados: x ñ DE. El GEM medido fue de 1.524 ñ 215 kcal/día. El GEE fue de 1.674 ñ 184, 1.656 ñ 233 y 1.606 ñ 247 kcal/día con F, F/O y S, respectivamente. La sobrestimación del GEM fue de 10,6 ñ 8,0 por ciento con F (151 ñ 12 kcal/día), 9,0 ñ 8,0 por ciento con F/O (132 ñ 14 kcal/día), y 5,7 ñ 9,0 por ciento con S (83 ñ 16 kcal/día). La siguiente ecuación describe el GEM (kcal/día) en el presente grupo: (13,2 x kg peso) + 596 en niñas, y (11,1 x kg peso) + 889 en niños. Conclusión: la amplia variabilidad en el GEM y su frecuente sobrestimación con las fórmulas hace recomendable efectuar mediciones individuales en niños obesos para la planificación de un programa de reducción ponderal

Gasto energético basal: variabilidad inter e intraindividual / Basal energy output: interindividual and intraindividual variability

La variabilidad intraindividual VI en el gasto energético basal medio GEM por calorimetría indirecta y la exactitud de las ecuaciones de Harris y Benedict, fue evaluada en 21 voluntarios adultos sanos. Se utilizó el método de circuito abierto con bolsa de Douglas y máscara facial con períodos de recolección de 5 minutos, con intervalos de 30 minutos, durante dos horas. El promedio de GEM fue de 19,5 ñ 2,6 y 22,4 ñ 3,9 kcal/kg/día en mujeres y varones, respectivamente. La VI del GEM, expresada como coeficiente de variación, fluctuó entre 6,2 y 14,7 por ciento en mujeres y entre 8,8 y 14,4 por ciento en hombres. La variación máxima entre dos mediciones del GEM fue de 27 por ciento en ambos grupos. La adecuación de Harris y Benedict sobreestimó el GEM en un 16,9 y 9,4 por ciento en mujeres y hombres, respectivamente, mostrando una precisión de ñ 16 por ciento en hombres y ñ 12 por ciento en mujeres. Se concluye que el gasto energético medido en condiciones basales presenta una importante variabilidad intraindividual, lo que obliga a efectuar más de una medición cuando se trabaja con este método