Comparison of Resting Energy Expenditure Assessment in Pediatric Oncology Patients.

BACKGROUND: Evaluation of energy requirements is an important part of the nutrition assessment of pediatric oncology patients. Adequate provision of energy in this population is of extreme importance because of the prevalence of malnutrition and its effect on growth, development, quality of life, morbidity, and mortality. Numerous methods are used in clinical practice for estimating the resting energy expenditures (REE), specifically indirect calorimetry and predictive equations. A relatively new instrument used to assess REE is the hand-held indirect calorimeter. The purpose of this quality improvement project was to compare the accuracy of REE measurements taken by a hand-held indirect calorimeter and predictive equations to that of a standard indirect calorimeter metabolic cart. METHODS: Patients receiving therapy for pediatric cancer, aged 7-18 years, and having a weight ≥15 kg and scheduled for a REE nutrition assessment were eligible. Sequentially, the patient's REE was assessed with the cart and the hand-held indirect calorimeter along with the predictive equation calculation. RESULTS: Post hoc pairwise comparisons revealed that all 3 methods were significantly different from one another (P < .0001). When compared with the cart, the portable hand-held calorimeter was found to underestimate REE by 11.9%, whereas predictive equations overestimated REE by 12.4%. CONCLUSION: Our quality improvement project suggests that the hand-held indirect calorimeter underestimated REE, and predictive equations overestimated REE in pediatric oncology nutrition assessment. Therefore, we recommend that these limitations in assessment be considered when assessing REE using a hand-held indirect calorimeter or predictive equations.

Oral Glutamine Supplementation Decreases Resting Energy Expenditure in Children and Adolescents With Sickle Cell Anemia.

OBJECTIVES: To determine the effects of orally administered glutamine on the resting energy expenditure (REE) and nutritional status of children and adolescents with sickle cell anemia. METHODS: Twenty-seven children and adolescents (13 boys, 14 girls), 5.2 to 17.9 years old (median 11.0 years), received orally administered glutamine (600 mg/kg per day) for 24 weeks. Measures of REE and other nutritional parameters were compared at baseline and 24 weeks. RESULTS: After 24 weeks, the patients' median REE (kcal/d) decreased by 6% (P = 0.053) as indicated by the Harris Benedict equations and by 5% (P = 0.049) as indicated by the modified equations. Patients with less than 90% ideal body weight had even greater declines in REE after 24 weeks (P < 0.03 and 0.02, respectively). Improvements in nutrition parameters and in two amino acids in the plasma were observed. CONCLUSIONS: After 24 weeks of orally administered glutamine, children and adolescents with sickle cell anemia had a decrease in REE and improvement in nutritional parameters. Those who were underweight had a greater decrease in REE than those of normal body weight. Lowering REE may be an effective way to improve the growth of these children and adolescents.

Oral glutamine supplementation decreases resting energy expenditure in children and adolescents with sickle cell anemia.

OBJECTIVES: To determine the effects of orally administered glutamine on the resting energy expenditure (REE) and nutritional status of children and adolescents with sickle cell anemia. METHODS: Twenty-seven children and adolescents (13 boys, 14 girls), 5.2 to 17.9 years old (median 11.0 years), received orally administered glutamine (600 mg/kg per day) for 24 weeks. Measures of REE and other nutritional parameters were compared at baseline and 24 weeks. RESULTS: After 24 weeks, the patients' median REE (kcal/d) decreased by 6% (P = 0.053) as indicated by the Harris Benedict equations and by 5% (P = 0.049) as indicated by the modified equations. Patients with less than 90% ideal body weight had even greater declines in REE after 24 weeks (P < 0.03 and 0.02, respectively). Improvements in nutrition parameters and in two amino acids in the plasma were observed. CONCLUSIONS: After 24 weeks of orally administered glutamine, children and adolescents with sickle cell anemia had a decrease in REE and improvement in nutritional parameters. Those who were underweight had a greater decrease in REE than those of normal body weight. Lowering REE may be an effective way to improve the growth of these children and adolescents.

Comparison of energy prediction equations with measured resting energy expenditure in children with sickle cell anemia.

OBJECTIVE: To determine the accuracy of energy prediction equations when compared with measured resting energy expenditure (REE) in children with sickle cell anemia. To develop a modified equation that more accurately estimates the energy needs of children with sickle cell anemia and to cross-validate these on a different set of patients (test patients). DESIGN: REE was measured in children using indirect calorimetry and compared with predicted values using the Harris-Benedict and the Food and Agriculture Organization/World Health Organization/United Nations University equations (WHO). SUBJECTS/SETTING: Eighteen patients participated in the original sample that compared predicted with measured energy expenditure. The modified equations were developed using the original 18 patients. A test population of 20 different patients was used to validate the modified equations. STATISTICAL ANALYSIS: Wilcoxon signed-rank test was performed to compare measured with predicted REE. The correlation analysis method and multiple linear regression method were used to develop 2 modified versions for the Harris-Benedict and WHO prediction equations. RESULTS: When compared with the mean predicted REE using the Harris-Benedict and WHO equations, the mean measured REE was 14% and 12% greater than both (P=.005 and P=.014, respectively). Two modified equations were developed from the Harris-Benedict and WHO equations. Based on the data from the test patients, the mean measured REE was 15% greater than the mean predicted REE based on the Harris-Benedict and WHO equations (P=.0001 for both). When the modified Harris-Benedict and WHO equations were used, there was almost no difference in the mean measured REE and the mean predicted REE (mean difference using Harris-Benedict = 14, P = .9273; mean difference using WHO = -13, P = .6215). CONCLUSION: Both energy prediction equations underestimated REE in children with sickle cell anemia. The 2 modified versions of the energy prediction equations that we propose predicted the energy needs of these children much more accurately; however, the modified equations need to be validated through application to other children with sickle cell anemia.