title: Measures of Total Energy Expenditure and Its Components Using the Doubly Labeled Water Method in Rehabilitating Burn Children.
abstract: A persistent hypermetabolic state delays anabolism and growth in burned children. However, our own clinical experience has been that resting energy expenditure (REE) is not increased during the rehabilitative phase, suggesting other contributing factors. We measured total energy expenditure (TEE) and its components in rehabilitating pediatric burn patients to identify the basis for accelerated energy metabolism in this population.
  
  
  
  Children admitted with initial burns of 20% of their total body surface area (TBSA) or greater were enrolled into this prospective, descriptive study. TEE was measured using the doubly labeled water method over a 7-day period. During that period, REE was measured on 2 days by indirect calorimetry. Activity energy expenditure (AEE) was assessed using a physical activity monitoring device for a 24-hour period. TEE and REE were compared with sex-specific, age-matched, and weight-matched norms using the Dietary Reference Intakes (DRI) standards.
  
  
  
  Ten children with an average burn size of 53.7% ± 20% (range, 27%-82%) of TBSA completed this study. Their mean age and weight were 10.4 ± 5.5 years and 35.8 ± 16.4 kg, respectively. Daily TEE averaged 66 kcal/kg and was 1.08% of reference DRI. REE was 92% ± 25% of predicted basal metabolic rate, not exceeding 120% as a maximum value in any child.
  
  
  
  TEE and REE in rehabilitating burn children are comparable to reference standards. Increased REE was not typical in our population, but measures of AEE were commonly high.
authors.affiliation: 1 Shriners Hospitals for Children, Boston, Massachusetts, USA.|2 Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Prelack
authors.affiliation: 1 Shriners Hospitals for Children, Boston, Massachusetts, USA.|2 Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Yong Ming
authors.initials: YM
authors.lastname: Yu
authors.affiliation: 1 Shriners Hospitals for Children, Boston, Massachusetts, USA.
authors.forename: Maggie
authors.initials: M
authors.lastname: Dylewski
authors.affiliation: 1 Shriners Hospitals for Children, Boston, Massachusetts, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Lydon
authors.affiliation: 1 Shriners Hospitals for Children, Boston, Massachusetts, USA.|3 Lawrence General Hospital, Lawrence, Massachusetts, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Keaney
authors.affiliation: 1 Shriners Hospitals for Children, Boston, Massachusetts, USA.|2 Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
mesh_terms: D000293:Adolescent; D000641:Ammonia / Q000652:urine; D001481:Basal Metabolism; D001823:Body Composition; D001830:Body Surface Area; D002056:Burns / Q000188:drug therapy* / Q000534:rehabilitation*; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D004032:Diet; D004734:Energy Metabolism; D015444:Exercise; D005998:Glycine / Q000008:administration & dosage / Q000737:chemistry; D006801:Humans; D009584:Nitrogen / Q000652:urine; D009587:Nitrogen Isotopes / Q000652:urine; D011446:Prospective Studies; D064167:Recommended Dietary Allowances; D014867:Water / Q000008:administration & dosage
chemical_list: D009587:Nitrogen Isotopes; D014867:Water; D000641:Ammonia; D003404:Creatinine; D009584:Nitrogen; D005998:Glycine
keywords: burns; life cycle; pediatrics; rehabilitation; research and diseases