title: Simple kcal/kg formula is comparable to prediction equations for estimating resting energy expenditure in older cognitively impaired long term care residents.
abstract: OBJECTIVE
  Assessment of energy needs is a critical step in developing the nutrition care plan, especially for individuals unable to modulate their own energy intakes. The purpose of this study was to assess precision and accuracy of commonly used prediction equations in comparison to measured resting energy expenditure in a sample of "oldest old" adults residing in long term care (LTC).
  
  
  METHODS
  Resting energy expenditure (mREE) was measured by indirect calorimetry in 45 residents aged 86.1 ± 7.3 years, and compared to frequently used prediction equations (pREE): Mifflin St.Jeor, Harris Benedict, World Health Organization and Owen. Precision and accuracy were determined by concordance correlation coefficients and number of individuals within ± 10% of mREE. Bland Altman plots with linear dependence trends were constructed to visualize agreement. To complete analyses, the common 25 kcal/kg formula was assessed and alternative formulas were determined for best fit by regressing adjusted mREE on body weight.
  
  
  RESULTS
  mREE averaged 976.2 ± 190.3 kcal/day for females and 1260.0 ± 275.9 kcal/d for males. The strength of the relationships between pREE and mREE were only moderate (r = 0.41 - 0.72). In examining linear trends in the Bland Altman plots, significant systematic deviation from mREE was detected for all pREE. Two kcal/kg formulas were generated: 20.6 kcal/kg for females and 22.7 kcal/kg for males, which were not significantly different.
  
  
  CONCLUSIONS
  None of the prediction equations adequately estimated energy needs in this sample of the "oldest old." A simple formula using 21-23 kcal/kg may be a more practical and reliable method to determine energy needs in the LTC setting.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Silver
authors.forename: R
authors.initials: R
authors.lastname: Wall
authors.forename: E
authors.initials: E
authors.lastname: Hollingsworth
authors.forename: A
authors.initials: A
authors.lastname: Pruitt
authors.forename: M
authors.initials: M
authors.lastname: Shotwell
authors.forename: S
authors.initials: S
authors.lastname: Simmons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001481:Basal Metabolism; D015992:Body Mass Index; D001835:Body Weight; D002140:California; D002153:Calorimetry, Indirect; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D009752:Nutritional Status; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic