scholarly journals Energy balance in critical illness

2003 ◽  
Vol 62 (2) ◽  
pp. 545-552 ◽  
Author(s):  
Lindsay D. Plank ◽  
Graham L. Hill
Keyword(s):  
Intensive Care ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Total Energy ◽  
Critically Ill ◽  
Energy Intake ◽  
The Body ◽  
Critically Ill Patient ◽  
Direct Calorimetry ◽  
Total Energy Balance

Energy balance is the difference between energy consumed and total energy expended. Over a given period of time it expresses how much the body stores of fat, carbohydrate and protein will change. For the critically-ill patient, who characteristically exhibits raised energy expenditure and proteolysis of skeletal muscle, energy balance information is valuable because underfeeding or overfeeding may compromise recovery. However, there are formidable difficulties in measuring energy balance in these patients. While energy intake can be accurately recorded in the intensive care setting, the measurement of total energy expenditure is problematic. Widely used approaches, such as direct calorimetry or doubly-labelled water, are not applicable to the critically ill patient. Energy balance was determined over periods of 5–10 d in patients in intensive care by measuring changes in the fat, protein and carbohydrate stores of the body. Changes in total body fat were positively correlated with energy balance over the 5 d study periods in patients with severe sepsis (n24, r 0.56, P=0.004) or major trauma (n 24, r 0.70, P<.0001). Fat oxidation occurred in patients whose energy intake was insufficient to achieve energy balance. Changes in body protein were independent of energy balance. These results are consistent with those of other researchers who have estimated total energy requirements from measurements of O2 consumption and CO2 production. In critically-ill patients achievement of positive non-protein energy balance or total energy balance does not prevent negative N balance. Nutritional therapy for these patients may in the future focus on glycaemic control with insulin and specialised supplements rather than on energy balance per se.

scholarly journals The Impact of Time of Day on Energy Expenditure: Implications for Long-Term Energy Balance

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2383 ◽  
Author(s):  
Shaw ◽  
Leung ◽  
Jong ◽  
Coates ◽  
Davis ◽  
...  
Keyword(s):  
Energy Balance ◽  
Energy Expenditure ◽  
Energy Intake ◽  
Experimental Studies ◽  
Time Of Day ◽  
Circadian System ◽  
The Body ◽  
Energy Regulation ◽  
Meal Timing ◽  
The Impact

There is evidence to indicate that the central biological clock (i.e., our endogenous circadian system) plays a role in physiological processes in the body that impact energy regulation and metabolism. Cross-sectional data suggest that energy consumption later in the day and during the night is associated with weight gain. These findings have led to speculation that when, as well as what, we eat may be important for maintaining energy balance. Emerging literature suggests that prioritising energy intake to earlier during the day may help with body weight maintenance. Evidence from tightly controlled acute experimental studies indicates a disparity in the body’s ability to utilise (expend) energy equally across the day and night. Energy expenditure both at rest (resting metabolic rate) and after eating (thermic effect of food) is typically more efficient earlier during the day. In this review, we discuss the key evidence for a circadian pattern in energy utilisation and balance, which depends on meal timing. Whilst there is limited evidence that simply prioritising energy intake to earlier in the day is an effective strategy for weight loss, we highlight the potential benefits of considering the role of meal timing for improving metabolic health and energy balance. This review demonstrates that to advance our understanding of the contribution of the endogenous circadian system toward energy balance, targeted studies that utilise appropriate methodologies are required that focus on meal timing and frequency.

scholarly journals Physical activity and energy balance

1999 ◽  
Vol 2 (3a) ◽  
pp. 335-339 ◽  
Author(s):  
Marleen A. Van Baak
Keyword(s):  
Physical Activity ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Total Energy ◽  
Energy Intake ◽  
Body Mass ◽  
Resting Energy Expenditure ◽  
Total Energy Expenditure ◽  
Activity Level ◽  
Resting Energy

AbstractEnergy expenditure rises above resting energy expenditure when physical activity is performed. The activity-induced energy expenditure varies with the muscle mass involved and the intensity at which the activity is performed: it ranges between 2 and 18 METs approximately. Differences in duration, frequency and intensity of physical activities may create considerable variations in total energy expenditure. The Physical Activity Level (= total energy expenditure divided by resting energy expenditure) varies between 1.2 and 2.2–2.5 in healthy adults. Increases in activity-induced energy expenditure have been shown to result in increases in total energy expenditure, which are usually greater than the increase in activity-induced energy expenditure itself. No evidence for increased spontaneous physical activity, measured by diary, interview or accelerometer, was found. However, this does not exclude increased physical activity that can not be measured by these methods. Part of the difference may also be explained by the post-exercise elevation of metabolic rate.If changes in the level of physical activity affect energy balance, this should result in changes in body mass or body composition. Modest decreases of body mass and fat mass are found in response to increases in physical activity, induced by exercise training, which are usually smaller than predicted from the increase in energy expenditure. This indicates that the training-induced increase in total energy expenditure is at least partly compensated for by an increase in energy intake. There is some evidence that the coupling between energy expenditure and energy intake is less at low levels of physical activity. Increasing the level of physical activity for weight loss may therefore be most effective in the most sedentary individuals.

scholarly journals Energy intake, physical activity and body weight: a simulation model

1995 ◽  
Vol 73 (3) ◽  
pp. 337-347 ◽  
Author(s):  
Klaas R. Westerterp ◽  
Jeroen H. H. L. M. Donkers ◽  
Elisabeth W. H. M. Fredrix ◽  
Piet oekhoudt
Keyword(s):  
Physical Activity ◽  
Body Composition ◽  
Body Weight ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Dietary Intake ◽  
Energy Intake ◽  
Relative Size ◽  
The Body ◽  
Fat Free Mass

In adults, body mass (BM) and its components fat-free mass (FFM) and fat mass (FM) are normally regulated at a constant level. Changes in FM and FFM are dependent on energy intake (EI) and energy expenditure (EE). The body defends itself against an imbalance between EI and EE by adjusting, within limits, the one to the other. When, at a given EI or EE, energy balance cannot be reached, FM and FFM will change, eventually resulting in an energy balance at a new value. A model is described which simulates changes in FM and FFM using EI and physical activity (PA) as input variables. EI can be set at a chosen value or calculated from dietary intake with a database on the net energy of foods. PA can be set at a chosen multiple of basal metabolic rate (BMR) or calculated from the activity budget with a database on the energy cost of activities in multiples of BMR. BMR is calculated from FFM and FM and, if necessary, FFM is calculated from BM, height, sex and age, using empirical equations. The model uses existing knowledge on the adaptation of energy expenditure (EE) to an imbalance between EI and EE, and to resulting changes in FM and FFM. Mobilization and storage of energy as FM and FFM are functions of the relative size of the deficit (EI/EE) and of the body composition. The model was validated with three recent studies measuring EE at a fixed EI during an interval with energy restriction, overfeeding and exercise training respectively. Discrepancies between observed and simulated changes in energy stores were within the measurement precision of EI, EE and body composition. Thus the consequences of a change in dietary intake or a change in physical activity on body weight and body composition can be simulated.

Energy availability and nutrition during a Special Force Qualification Course (Q-Course)

2018 ◽  
Vol 165 (5) ◽  
pp. 325-329 ◽  
Author(s):  
Patrick Mullie ◽  
P Clarys ◽  
W De Bry ◽  
P Geeraerts
Keyword(s):  
Energy Balance ◽  
Energy Expenditure ◽  
Total Energy ◽  
Energy Intake ◽  
Negative Energy ◽  
Fat Free Mass ◽  
Energy Availability ◽  
Food Diary ◽  
Total Energy Consumption ◽  
The Mean

IntroductionThe Special Forces (SF) are an elite military group usually engaged in physically demanding field operations, resulting among others in high daily energy requirements. Optimising energy supply and nutritional requirements is therefore mandatory for success. The aim of this study was to estimate energy availability and nutrition during a Qualification Course (Q-Course) for Belgian SF.Methods21 participants recorded all foods and beverages consumed during four days in a structured food diary. Energy expenditure was measured with an accelerometer and fat mass measured with quadripolar impedance. Energy availability was calculated by the following formula: (energy intake by foods and beverages − energy expenditure for physical activity)/kg FFM/day (FFM, fat-free mass).ResultsThe mean (SD) total energy expenditure was 4926 kcal/day (238), with a minimum of 4645 kcal/day and a maximum of 5472 kcal/day. The mean (SD) total energy consumption was 4186 kcal/day (842), giving an energy balance ranging from −2005 kcal/day to 1113 kcal/day. The mean (SD) energy availability was 17 kcal/kg FFM/day, with a minimum of 1 kcal/kg FFM/day and a maximum of 44 kcal/kg FFM/day. The mean (SD) intake of carbohydrates was 6.8 g/kg body weight/day (1.5).ConclusionsDuring this studied Q-Course, energy intake was not optimal as demonstrated by an overall negative energy balance and low energy availability. High interindividual variations in energy intake were found, highlighting the importance of providing SF members nutritional education.

scholarly journals The EnergyKids project: pilot study on the energy balance of primary school children during school days and summer camp days

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Alice Rosi ◽  
Cinzia Franchini ◽  
Francesca Scazzina
Keyword(s):  
Energy Balance ◽  
Energy Expenditure ◽  
Total Energy ◽  
Energy Intake ◽  
Weight Status ◽  
Summer Camp ◽  
Total Energy Expenditure ◽  
Primary School Children ◽  
Daily Energy ◽  
The Mean

AbstractSpecific nutritional requirements should be cover during childhood to ensure proper growth. The daily energy need is defined as the number of calories necessary to satisfy the total energy expenditure in a healthy and active organism. Since children are more inclined to be physically active during summer, their energy expenditure may vary during school days respect to summer days and a proper energy intake should be planned during both periods.The primary aim of this study was to evaluate the energy balance during school days and summer camp days in primary school children living in the city of Parma (Italy), attending the Giocampus programme.Participants were asked to complete a 3-day weighed food diary and to wear an activity tracker for the same 3 consecutive days twice: within a school week and a summer camp week. Height and body weight were measured at the beginning of each assessment week and BMI was calculated to define the weight status through the IOTF gender- and age-related cut-offs for children BMI. The mean energy balance was estimated as the difference between the mean total energy expenditure (calculated multiplying the daily physical activity level by the basal metabolic rate from the Schofield's predictive equation) and the mean daily energy intakes (obtained through the Italian food database of the European Institute of Oncology).Fifty-five children (49% F, 51% M, 8–10 y) correctly completed the study. In both periods, the mean BMI corresponded to normal weight status, without significant differences between genders. Energy intake did not change significantly between the assessment periods or between sexes. As expected, the minutes of inactivity decreased during the summer camp period. Moreover, males were more active than females, but the increase in the total energy expenditure from school to summer camp, related to the increased physical activity, was significant in both sexes. Energy balance was negative in both assessment periods and it changed significantly from school to summer camp days, decreasing in both sexes but being more negative for boys than for girls.Our results underline the importance of providing children with meals nutritionally adequate and suggest that the energy content of children's meals should be increased during particular conditions, like a summer camp, and continuously monitored to assure an adequate energy intake to cover the energy requirements during both school and summer camp days.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

scholarly journals The effect of breakfast on appetite regulation, energy balance and exercise performance

2015 ◽  
Vol 75 (3) ◽  
pp. 319-327 ◽  
Author(s):  
David J. Clayton ◽  
Lewis J. James
Keyword(s):  
Energy Balance ◽  
Energy Expenditure ◽  
Energy Intake ◽  
Exercise Performance ◽  
Intervention Studies ◽  
Precise Determination ◽  
Positive Energy ◽  
Cross Sectional ◽  
Positive Energy Balance ◽  
The Impact

The belief that breakfast is the most important meal of day has been derived from cross-sectional studies that have associated breakfast consumption with a lower BMI. This suggests that breakfast omission either leads to an increase in energy intake or a reduction in energy expenditure over the remainder of the day, resulting in a state of positive energy balance. However, observational studies do not imply causality. A number of intervention studies have been conducted, enabling more precise determination of breakfast manipulation on indices of energy balance. This review will examine the results from these studies in adults, attempting to identify causal links between breakfast and energy balance, as well as determining whether consumption of breakfast influences exercise performance. Despite the associations in the literature, intervention studies have generally found a reduction in total daily energy intake when breakfast is omitted from the daily meal pattern. Moreover, whilst consumption of breakfast supresses appetite during the morning, this effect appears to be transient as the first meal consumed after breakfast seems to offset appetite to a similar extent, independent of breakfast. Whether breakfast affects energy expenditure is less clear. Whilst breakfast does not seem to affect basal metabolism, breakfast omission may reduce free-living physical activity and endurance exercise performance throughout the day. In conclusion, the available research suggests breakfast omission may influence energy expenditure more strongly than energy intake. Longer term intervention studies are required to confirm this relationship, and determine the impact of these variables on weight management.

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