Energy expenditure and caloric balance after burn: increased feeding leads to fat rather than lean mass accretion.
OBJECTIVE
Resting energy expenditure (REE) is commonly measured in critical illness to determine caloric "demands" and thus nutritive needs.


BACKGROUND
The purpose of this study was to 1) determine whether REE is associated with clinical outcomes and 2) determine whether an optimal caloric delivery rate based on REE exists to offset erosion of lean mass after burn.


METHODS
From 1995 to 2001, REE was measured by indirect calorimetry in 250 survivors of 10 to 99%TBSA burns. Caloric intake and REE were correlated with muscle protein catabolism, length of stay, ventilator dependence, sepsis, and mortality. From 1998 to 2000, 42 patients (>60%TBSA burns) received continuous enteral nutrition at a spectrum of caloric balance between 1.0x REE kcal/d -1.8x REE kcal/d. Serial body composition was measured by dual energy x-ray absorptiometry. Lean mass, fat mass, morbidity, and mortality were determined.


RESULTS
REE/predicted basal metabolic rate correlated directly with burn size, sepsis, ventilator dependence, and muscle protein catabolism (P <.05). Declining REE correlated with mortality (P <.05). 2) Erosion of lean body mass was not attenuated by increased caloric balance, however, fat mass increased with caloric supply (P <.05).


CONCLUSIONS
In surviving burned patients, caloric delivery beyond 1.2 x REE results in increased fat mass without changes in lean body mass. Declining energy expenditure appears to be a harbinger of mortality in severely burned patients.
Hart
David W
DW
University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas 77550-1220, USA.
Wolf
Steven E
SE
Herndon
David N
DN
Chinkes
David L
DL
Lal
Sophia O
SO
Obeng
Michael K
MK
Beauford
Robert B
RB
Mlcak RT
Ronald P
RP
D000273:Adipose Tissue / Q000378:metabolism; D000293:Adolescent; D001481:Basal Metabolism; D001823:Body Composition; D015992:Body Mass Index; D002056:Burns / Q000378:metabolism* / Q000628:therapy; D002151:Calorimetry; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D002149:Energy Intake; D004734:Energy Metabolism; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008962:Models, Theoretical; D009124:Muscle Proteins / Q000378:metabolism*; D012106:Research
D009124:Muscle Proteins