Resting energy expenditure and body composition in bedridden institutionalized elderly women with advanced-stage pressure sores.
BACKGROUND
Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size.


METHODS
The study involved 52 institutionalized bedridden elderly women (aged 83.7 +/- 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured.


RESULTS
The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 +/- 236.7 vs 1085.5 +/- 161.3 kcal/d; p <.05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 +/- 6.7 vs 21.1 +/- 4.0 kcal/d/kg; p <.01). Hypermetabolism, i.e., a measured REE > 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (DeltaREE) correlated with PS volume (r = 0.58; p <.01), but not with area.


CONCLUSIONS
Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.
Sergi
Giuseppe
G
Department of Medical and Surgical Sciences, Division of Geriatrics, University of Padua, Padua, Italy. giuseppe.sergi@unipd.it
Coin
Alessandra
A
Mulone
Silvana
S
Castegnaro
Eugenio
E
Giantin
Valter
V
Manzato
Enzo
E
Busetto
Luca
L
Inelmen
Emine Meral
EM
Marin
Sara
S
Enzi
Giuliano
G
D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001481:Basal Metabolism / Q000502:physiology*; D001823:Body Composition / Q000502:physiology*; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002153:Calorimetry, Indirect; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D007326:Institutionalization; D009752:Nutritional Status; D011228:Prealbumin / Q000032:analysis; D003668:Pressure Ulcer / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D012177:Retinol-Binding Proteins / Q000032:analysis; D012709:Serum Albumin / Q000032:analysis
D011228:Prealbumin; D012177:Retinol-Binding Proteins; D012709:Serum Albumin