scholarly journals Insights into energy requirements in disease

2005 ◽  
Vol 8 (7a) ◽  
pp. 1037-1052 ◽  
Author(s):  
Marinos Elia
Keyword(s):  
Chronic Diseases ◽  
Good Health ◽  
Total Energy Expenditure ◽  
Energy Requirements ◽  
Accurate Information ◽  
Doubly Labelled Water ◽  
Tracer Techniques ◽  
Energy Needs ◽  
Wide Range ◽  
Ventilated Patients

AbstractAccurate information about the energy needs of a range of acute and chronic diseases and morbidity is lacking and often complicated by the medication prescribed to treat the condition and also because of the presence of pre-existing malnutrition. Assessing the energy requirements of patients with acute and chronic diseases is more complex than for those in good health. These requirements not only depend on the aggressiveness of the disease and level of inactivity it causes, but also on the treatment, and the presence of prior malnutrition. It used to be generally believed that the energy requirements were increased in a number of diseases. It is now realised that this is not usually the case. Therefore, it is necessary to put these changing ideas into context by considering a wide range of acute and chronic diseases which this paper proposes to do. This paper is almost exclusively restricted to studies that have measured total energy expenditure (TEE) using tracer techniques in both hospital and the community (mostly doubly labelled water and to a lesser extent bicarbonate–urea), and continuous 24–hour indirect calorimetry in artificially ventilated patients in hospital.

scholarly journals Energy expenditure in disease: time to revisit?

2000 ◽  
Vol 59 (2) ◽  
pp. 199-207 ◽  
Author(s):  
Eileen R. Gibney
Keyword(s):  
Energy Expenditure ◽  
Total Energy ◽  
Energy Requirement ◽  
Total Energy Expenditure ◽  
Energy Requirements ◽  
Direct Result ◽  
Free Living ◽  
Doubly Labelled Water ◽  
Tracer Techniques ◽  
Urea Method

Knowledge of energy expenditure is especially important in disease, and may in fact help in the understanding of the pathophysiology of wasting associated with disease. Energy requirements in a clinical setting are often ‘prescribed’ by health professionals, either directly through enteral or parenteral feeding, or perhaps controlled through a hospital diet. Studies initially suggested an increase in energy expenditure, and thus energy requirements, as a direct result of an increase in basal metabolic rate often seen in disease. However, many problems exist in the measurement of BMR in a disease situation, due to the effects of drugs, clinical practice, feeding or possibly anxiety either as a cause of the disease or the measurement itself. These problems could in themselves contribute to the rise in metabolism seen in disease. More recently, however, with the use of tracer techniques such as doubly-labelled water and the bicarbonate–urea method, more accurate estimates of energy expenditure, and thus energy requirements, have been made. Some such measurements have in fact shown that even with an elevated BMR, free-living total energy expenditure can in fact be reduced in many disease situations, suggesting a reduced rather than an increased energy requirement. The present review investigates measurements of total energy expenditure in disease to explore the hypothesis that energy expenditure in disease, even with an elevated BMR, can in fact be reduced due to a concurrent reduction in physical activity.

scholarly journals Energy intake in short bowel syndrome: assessment by 24-h dietary recalls compared with the doubly labelled water method

2017 ◽  
Vol 119 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Priscila G. Fassini ◽  
Sai Krupa Das ◽  
Karina Pfrimer ◽  
Vivian M. M. Suen ◽  
Júlio Sérgio Marchini ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Energy Intake ◽  
Total Energy Expenditure ◽  
Severe Malnutrition ◽  
Control Groups ◽  
Doubly Labelled Water ◽  
Short Bowel ◽  
Energy Needs ◽  
And Control

AbstractShort bowel syndrome (SBS) represents a serious intestinal absorption disorder, and patients may be prone to severe malnutrition. Dietetic therapy is critically important both for immediate prognosis and successful long-term rehabilitation. To maintain energy balance, an accurate assessment of energy intake is required. Our objective was to compare energy intake (EI) assessed by 24-h dietary recalls (EIrecall), a standard clinical assessment, with the total energy expenditure measured by the doubly labelled water (TEEdlw) method in SBS patients and matched controls. A total of twenty-two participants (eleven each in the SBS and control groups (CG), six female and five male) were evaluated; CG were matched to SBS patients on the basis of age, BMI and sex. TEE was measured by DLW and compared with EI determined by four 24-h dietary recalls using the USDA Automated Multiple-Pass Method. Bland–Altman plots and paired Student’s t test were used to compare EIrecall with TEEdlw (P<0·05). Participants’ mean age was 53 (sd 8) years. TEEdlw (7·85 (SD 1·16) MJ/d, 0·14 (SD 0·02) MJ/kg per d) was significantly lower (P=0·014) compared with EIrecall (11·07 (SD 3·45) MJ/d, 0·21 (SD 0·08) MJ/kg per d) in the SBS group. On the other hand, in the CG group TEEdlw (10·02 (SD 1·86) MJ/d, 0·18 (SD 0·03) MJ/kg per d) was significantly higher (P=0·001) compared with EIrecall (7·19 (SD 1·68) MJ/d, 0·13 (SD 0·03) MJ/kg per d). In SBS patients, reported EI is higher than DLW-measured EI. Therefore, providing or prescribing energetic intake based on EIrecall without accounting for potential malabsorption-related losses can compromise the energy needs in SBS patients and affect nutritional status in the long term.

scholarly journals Energy expenditure in early infancy

1989 ◽  
Vol 62 (3) ◽  
pp. 621-629 ◽  
Author(s):  
Peter. S. W. Davies ◽  
G. Ewing ◽  
A. Lucas
Keyword(s):  
Body Weight ◽  
Energy Metabolism ◽  
Energy Expenditure ◽  
Total Energy ◽  
Total Energy Expenditure ◽  
Early Infancy ◽  
Energy Requirements ◽  
Term Infants ◽  
Doubly Labelled Water ◽  
Disease States

The measurement of energy expenditure has wide applications in clinical and scientific studies. Ethical and practical problems, however, have limited the acquisition of information on total energy expenditure in infancy. The doubly-labelled-water technique, recently validated for use in infants, has now been used to measure, non-invasively, total energy expenditure in a cohort of forty-one normal, full-term infants at or close to 1·5, 3 and 6 months of age. Mean total energy expenditure was 270, 280 and 330 kJ/kg per d at these ages. Centiles for total energy expenditure in early infancy are presented; it is suggested such data are most appropriately expressed as kJ/√ (kg body-weight per d). These findings will be of importance in the re-evaluation of energy requirements in infancy and in the study of lesions in energy metabolism in disease states at this age.

scholarly journals Energy requirements of infants

2005 ◽  
Vol 8 (7a) ◽  
pp. 953-967 ◽  
Author(s):  
Nancy F Butte
Keyword(s):  
Energy Expenditure ◽  
Total Energy ◽  
Energy Intake ◽  
Energy Deposition ◽  
Total Energy Expenditure ◽  
Energy Requirements ◽  
Term Infants ◽  
Doubly Labelled Water

AbstractObjectiveTo estimate the energy requirements of infants from total energy expenditure and energy deposition during growth.DesignEnergy requirements during infancy were estimated from total energy expenditure measured by the doubly labelled water method and energy deposition based on measured protein and fat gains.SettingDatabase on the total energy expenditure and energy deposition of infants was compiled from available studies conducted in China, Chile, Gambia, Mexico, Netherlands, UK, and USA.SubjectsHealthy, term infants.ResultsTotal energy requirements (kJ day−1) increased with age and were higher in boys than girls due to differences in weight. Energy requirements decreased from 473 kJ kg−1per day for boys and 447 kJ kg−1per day for girls at 1 month of age to 337 kJ kg−1per day for boys and 341 kJ kg−1per day for girls at 6 months of age, and thereafter tended to plateau. Energy deposition as a percentage of total energy requirements decreased from 40% at 1 month to 3% at 12 months of age. These estimates are 10–32% lower than the 1985 FAO/WHO/UNU recommendations which were based on observed energy intakes of infants.ConclusionsRecommendations for the energy intake of infants should be revised based on new estimates of total energy expenditure and energy deposition.

scholarly journals Validation of energy requirement references for exclusively breast-fed infants

2012 ◽  
Vol 109 (11) ◽  
pp. 2036-2043 ◽  
Author(s):  
Susan B. Nielsen ◽  
Jonathan C. K. Wells ◽  
Mary S. Fewtrell ◽  
Simon Eaton ◽  
James Grinham ◽  
...  
Keyword(s):  
Body Weight ◽  
Energy Requirement ◽  
Population Level ◽  
Prediction Equation ◽  
Total Energy Expenditure ◽  
Energy Requirements ◽  
Doubly Labelled Water ◽  
Factorial Approach ◽  
Paediatric Practice ◽  
Breast Fed

In paediatric practice, mean reference energy requirements for groups are often used to predict individual infant energy requirements. References from the FAO/WHO/United Nations University are based on infants not fed according to the current infant feeding recommendations. The objective of the present study was to measure total energy expenditure (TEE) and determine energy requirements using criterion methods, and validate the use of TEE prediction equation and mean energy requirement references for predicting individual TEE and energy requirements, respectively, in infants who were exclusively breast-fed (EBF) to 6 months of age. EBF infants were included from Greater Glasgow for measurements at 3·5 (n 36) and 6 (n 33) months of age. TEE was measured using doubly labelled water and energy requirements were determined using the factorial approach. TEE and energy requirements were also predicted using equations based on body weight. Relationships between criterion methods and predictions were assessed using correlations. Paired t tests and Bland–Altman plots were used to assess agreement. At the population level, predicted and measured TEE were similar. The energy requirement reference significantly underestimated energy requirements by 7·2 % at 3·5 months at the population level, but there was no bias at 6 months. Errors at individual levels were large and energy requirements were underestimated to a larger extent for infants with higher energy requirements. This indicates that references presently used in clinical practice to estimate energy requirements may not fully account for the different growth pattern of EBF infants. More studies in infants EBF to 6 months of age are needed to understand how growth of EBF infants influences energy requirements.

scholarly journals Estimating energy requirements: regression based prediction equations or multiples of resting metabolic rate

2005 ◽  
Vol 8 (7a) ◽  
pp. 1184-1186 ◽  
Author(s):  
Michael I Goran
Keyword(s):  
Physical Activity ◽  
Body Weight ◽  
Energy Expenditure ◽  
Metabolic Rate ◽  
Resting Metabolic Rate ◽  
Total Energy Expenditure ◽  
Energy Requirements ◽  
Activity Levels ◽  
Doubly Labelled Water ◽  
Alternative Approaches

AbstractEnergy requirements have traditionally been determined based on multiples of resting metabolic rate (RMR), known as Physical Activity Levels (PAL). With more data from doubly labelled water studies alternative approaches for estimating energy requirements have been suggested. Statistical analysis reveals that body weight explains more of the variance in total energy expenditure (TEE) than does RMR. The explanation for this phenomenon is that body weight contributes to the variance of both RMR and the other major determinant of TEE, i.e. physical activity related energy expenditure. Thus, in effect, the regression-based approach provides a more physiological appropriate model for TEE. Its major departure from tradition, difference from current adult proposals, and time taken for acceptance are the disadvantages of the regression-based approach.

scholarly journals Long-term adequacy of exclusive breast-feeding: how scientific research has led to revised opinions

2000 ◽  
Vol 59 (1) ◽  
pp. 17-23 ◽  
Author(s):  
R. G. Whitehead ◽  
A. A. Paul
Keyword(s):  
Breast Milk ◽  
Basic Assumption ◽  
Nutrient Content ◽  
Energy Requirements ◽  
Dietary Energy ◽  
Doubly Labelled Water ◽  
Nutritional Guidelines ◽  
Energy Needs ◽  
High Bioavailability

The present paper reviews the research of the authors and their colleagues over the past 20 years to provide improved nutritional and anthropometric guidelines for the assessment of lactational adequacy and for when the weaning process might be initiated. The nutritional guidelines are based on revised dietary energy requirements. The basic assumption is that since breast milk is a well-balanced food, if energy needs are satisfied so will those for essential nutrients. Energy requirements for young babies have been derived from the application of the doubly-labelled-water technique. This approach indicated that 460 kJ (110 kcal)/kg per d at 1 month and 397 and 355 kJ (95 and 85 kcal)/kg per d at 3 and 6 months respectively would be satisfactory for a nutrient content of high bioavailability. Translated into a breast-milk intake of 850 ml/d the latter would cover the dietary energy needs of the average child growing along the 50th centile until at least 4 months, but the typical child from many developing countries following the 25th centile until 6 months. The importance of revised growth reference values for infancy, equally crucial for assessing lactational adequacy, is also reviewed. In contrast with the shapes of earlier reference patterns, growth trajectories are different when babies are fed in accordance with modern paediatric advice. Mothers and health professionals using the older growth charts to assess the progress of a baby can be misled into assuming that the weaning process needs to be introduced sooner than necessary. Examples of this situation within the context of a developing country are provided.

scholarly journals Resting energy expenditure, activity energy expenditure and total energy expenditure at age 91–96 years

2000 ◽  
Vol 84 (3) ◽  
pp. 319-324 ◽  
Author(s):  
Elisabet M. Rothenberg ◽  
Ingvar G. Bosaeus ◽  
Klaas R. Westerterp ◽  
Bertil C. Steen
Keyword(s):  
Physical Activity ◽  
Energy Expenditure ◽  
Total Energy ◽  
Oldest Old ◽  
The Elderly ◽  
Total Energy Expenditure ◽  
Activity Level ◽  
Energy Requirements ◽  
Doubly Labelled Water ◽  
Activity Energy

There is a limited knowledge concerning energy requirements of the elderly, especially the oldest old (> 80 years). Energy requirements should be estimated from measurements of energy expenditure. For this purpose twenty-one free-living individuals (eight males, thirteen females) aged 91–96 years living in Göteborg, Sweden were studied. Total body water (TBW) measured by the doubly-labelled-water (DLW) technique was 29·5 (SD 5·4) KG IN FEMALES AND 35·6 (sd 4·3) kg in males. TBW measured using bioelectric impedance (BIA) was 31·6 (sd 6·4) kg in females and 42·0 (sd 7·4) kg in males. The mean difference between TBW measured by BIA and that measured by DLW was 3·54 (sd 3·6) kg (P = 0·0002). Resting metabolic rate (RMR) was measured using a ventilated-hood system and averaged 5·36 (sd 0·71) MJ/d in females (n 12) and 6·09 (sd 0·91) MJ/d in males (n 8). Difference between measured RMR and predicted BMR (n 20) was 0·015 (sd 0·86) MJ/d (NS). Total energy expenditure (TEE) measured by DLW averaged 6·3 (sd 0·81) MJ/d in females and 8·1 (sd 0·73) MJ/d in males. Activity energy expenditure (TEE - RMR), thus including diet-induced thermogenesis (DIT), averaged 0·95 (sd 0·95) MJ/d in females (n 12) and 2·02 (sd 1·13) MJ/d in males. Physical activity level (TEE/BMR) averaged 1·19 (sd 0·19) in females and 1·36 (sd 0·21) (P = 0·08) in males. If DIT is assumed to be 10 % of the TEE, energy spent on physical activity will be very low in this population.

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