How accurate are resting energy expenditure prediction equations in obese trauma and burn patients?
BACKGROUND
While the prevalence of obesity continues to increase in our society, outdated resting energy expenditure (REE) prediction equations may overpredict energy requirements in obese patients. Accurate feeding is essential since overfeeding has been demonstrated to adversely affect outcomes.


OBJECTIVE
The first objective was to compare REE calculated by prediction equations to the measured REE in obese trauma and burn patients. Our hypothesis was that an equation using fat-free mass would give a more accurate prediction. The second objective was to consider the effect of a commonly used injury factor on the predicted REE.


METHODS
A retrospective chart review was performed on 28 patients. REE was measured using indirect calorimetry and compared with the Harris-Benedict and Cunningham equations, and an equation using type II diabetes as a factor. Statistical analyses used were paired t test, +/-95% confidence interval, and the Bland-Altman method.


RESULTS
Measured average REE in trauma and burn patients was 21.37 +/- 5.26 and 21.81 +/- 3.35 kcal/kg/d, respectively. Harris-Benedict underpredicted REE in trauma and burn patients to the least extent, while the Cunningham equation underpredicted REE in both populations to the greatest extent. Using an injury factor of 1.2, Cunningham continued to underestimate REE in both populations, while the Harris-Benedict and Diabetic equations overpredicted REE in both populations.


CONCLUSIONS
The measured average REE is significantly less than current guidelines. This finding suggests that a hypocaloric regimen is worth considering for ICU patients. Also, if an injury factor of 1.2 is incorporated in certain equations, patients may be given too many calories.
Stucky
Chee-Chee H
CC
University of Kansas School of Medicine, Department of Surgery, University of Kansas Hospital, Kansas City, KS 66160, USA. cstucky@kumc.edu
Moncure
Michael
M
Hise
Mary
M
Gossage
Clint M
CM
Northrop
David
D
D001481:Basal Metabolism / Q000502:physiology*; D015992:Body Mass Index; D002056:Burns / Q000378:metabolism*; D002153:Calorimetry, Indirect / Q000592:standards; D015331:Cohort Studies; D016638:Critical Illness; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008433:Mathematics; D008875:Middle Aged; D009751:Nutritional Requirements; D009765:Obesity / Q000378:metabolism*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014947:Wounds and Injuries / Q000378:metabolism*