Resting Energy Expenditures Measured by Indirect Calorimetry are Higher In Preadolescent Children with Cystic Fibrosis than Expenditures Calculated from Prediction Equations

doi:10.1016/S0002-8223(95)00009-7

Journal of the American Dietetic Association

Volume 95, Issue 1, January 1995, Pages 30-33

https://doi.org/10.1016/S0002-8223(95)00009-7 Get rights and content

Abstract

Objective This study compared measured resting energy expenditures to resting energy expenditures calculated using Harris-Benedict equations (HBEs) and the Cystic Fibrosis Consensus Committee equations (CFCCEs).

Design We studied 31 preadolescent boys and girls with cystic fibrosis who ranged in age from 3.25 to 12.75 years old. The patients were afebrile and not in pulmonary distress. Measured resting energy expenditures were determined using a portable metabolic measurement cart with fully automated calibration and data management. The measured resting energy expenditures obtained were compared with values obtained using HBEs and CFCCEs.

Results For each patient, the measured resting energy expenditure value was above the predicted resting energy expenditure values derived from HBEs (P≤.0001) and CFCCEs (P≤.01).

Applications The HBEs and the CFCCEs underestimated the energy expenditures of the study population by 13% and 8%, respectively. These findings support the usefulness of the measurement of energy expenditures in determining the energy needs of preadolescent patients with cystic fibrosis. In clinical practice, the resting energy expenditures would be multiplied by activity coefficients to determine the total daily energy expenditures of this population. J Am Diet Assoc. 1995; 95:30–33.

Section snippets

Subjects

Data for this study were collected in the Handicapped Children's Clinic, a CF treatment facility at Louisiana State University in Shreveport. Approval was granted by the Institutional Review Board for Human Research at Louisiana State University and the Human Subjects Review Committee of Texas Woman's University, Denton. Approved consent forms were signed by parents and witnessed.

Thirty-one preadolescent boys and girls (ranging in age from 3.25 to 12.75 years) who were afebrile and were not in

Results

The patients’ actual weight measurements were compared with the WHO values for height and weight (Table 1) (17). The mean actual weight-for-height values in 25 of the 31 subjects were normal compared with WHO values for weight and height. None of the 31 subjects were below the fifth percentile in weight when height was greater than the fifth percentile.

Ratios of height to weight (z scores) were determined and were normalized for age and gender (Table 2) (21). The z scores indicate that the

Discussion

Several authors have suggested that the energy requirements of patients with CF are greater than the requirements of comparable, healthy subjects (8), (9), (22), (23), (24), (25), (26). Studies have also shown that the resting energy expenditures of CF patients were greater than calculated expenditures for comparable healthy groups when HBEs were used (26). In two extensive reviews of literature related to energy expenditure equations, Roza and Shizgal (27) and Geissler et al (28) reported

Applications

The data from this study suggest that indirect calorimetry is applicable for measuring resting energy expenditure in preadolescent children with CF and that HBEs and the CFCCEs are not adequate predictors of the resting energy needs of preadolescent CF patients. These findings support the recommendation that children with CF should have their energy expenditures measured at regular intervals, so that their individual energy requirements can be assessed. Measurement of energy expenditure is

References (34)

M.M. Barry
Cystic fibrosis
J Am Diet Assoc.
(1979)
H.P. Chase et al.
Cystic fibrosis and malnutrition
J Pediatr.
(1979)
V.S. Hubbard et al.
Energy intake and nutrition counseling in cystic fibrosis
J Am Diet Assoc.
(1982)
B.W. Ramsey et al.
the GF Consensus Committee. Nutritional assessment and management in cystic fibrosisa consensus report
Am J Clin Nutr.
(1992)
R.W. Shepherd et al.
Increased energy expenditure in young children with cystic fibrosis
Lancet
(1988)
J.E. Grunow et al.
Energy expenditure in cystic fibrosis during activities of daily living
J Pediatr.
(1993)
H. Naon et al.
Resting energy expenditureevolution during antibiotic treatment for pulmonary exacerbation in cystic fibrosis
Chest.
(1993)
A.M.W.J. Schols et al.
Resting energy expenditure in patients with chronic obstructive pulmonary disease
Am J Clin Nutr.
(1991)
A.M. Roza et al.
The Harris-Benedict equation reevaluatedresting energy requirements and the body cell mass
Am J Clin Nutr.
(1984)
C.A. Geissler et al.
Validation of a field technique for the measurement of energy expenditurefactorial method versus continuous respirometry
Am J Clin Nutr.
(1986)

J.M. Bertrand et al.

Short-term clinical nutritional and functional effects of continuous enteral alimentation in children with cystic fibrosis

J Pediatr.

(1984)

D.H. Anderson

Cystic fibrosis of the pancreas and its relation to celiac diseasea clinical and pathologic study

Am J Dis Child.

(1938)

P.A. di Sant’Agnese et al.

Abnormal electrolyte composition of sweat in cystic fibrosis of the pancreasclinical significance and relationship to the disease

Pediatrics.

(1953)

W.R. Gerson et al.

Nutrition support in cystic fibrosis

Nutr Rev.

(1987)

J.D. Lloyd-Still

Textbook of Cystic Fibrosis

(1983)

D.D. Roy et al.

A rational approach to meeting macro- and micronutrient needs in cystic fibrosis

J Pediatr Gastroenterol Nutr.

(1984)

Food and Nutrition Board. Recommended Dietary Allowances.10th ed. Washington, DC: National Academy Press;...

Cited by (19)

Energy Expenditure, Nutrition Status, and Body Composition in Children With Cystic Fibrosis
2004, Nutrition
Undernutrition is a frequent complication in patients with cystic fibrosis (CF). Elevated energy requirements have been found to be 4% to 33% higher than in controls in some studies. Whether or not this is caused by a primary defect or energy metabolism is still a matter of controversy. To this end, we assessed energy expenditure, nutrition status, and body composition of clinically stable CF outpatients.
Fifteen clinically stable CF patients, ages 2 to 15 y, were paired with 15 healthy control children. Measurements consisted of anthropometry and body composition. Plasma tocopherol, retinol, and hair zinc content were measured. Resting energy expenditure was determined by indirect calorimetry. Physical activity and dietary intake were recorded by recall methods.
Two children were nutritionally at risk according to the weight/height index, eight were normal, three were overweight, and two were obese. Body composition was similar in both groups. Zinc, tocopherol, and retinol levels were low in three, two, and three patients, respectively. Resting energy expenditures were 4.7 MJ/d (1127 ± 220 kcal/d) in CF children and 4.63 MJ/d (1108 ± 191 kcal/d) in control children (P = not significant). Physical activity level was sedentary in 86.6% of CF patients; the rest had a light physical activity pattern. Energy intake represented 141% of the estimated daily energy expenditure.
Non–oxygen-dependent CF children, without acute respiratory infection, had resting energy expenditures comparable to those of matched controls. Total energy expenditure was similar to or slightly lower than that in healthy children. Dietary recommendations for CF patients need to be reassessed.
Question 1. How does nutritional status influence the development of cystic fibrosis? Pathophysiological aspect of nutritional disorders in cystic fibrosis
2003, Archives de Pediatrie
Energy expenditure and the body cell mass in cystic fibrosis
2001, Nutrition
Poor nutritional status in patients with cystic fibrosis (CF) is associated with severe lung disease, and possible causative factors include inadequate intake, malabsorption, and increased energy requirements. Body cell mass (which can be quantified by measurement of total body potassium) provides an ideal standard for measurements of energy expenditure. The aim of this study was to compare resting energy expenditure (REE) in patients with CF with both predicted values and age-matched healthy children and to determine whether REE was related to either nutritional status or pulmonary function. REE was measured by indirect calorimetry and body cell mass by scanning with total body potassium in 30 patients with CF (12 male, mean age = 13.07 ± 0.55 y) and 18 healthy children (six male, mean age = 12.56 ± 1.25 y). Nutritional status was expressed as a percentage of predicted total body potassium. Lung function was measured in the CF group by spirometry and expressed as the percentage of predicted forced expiratory volume in 1 s. Mean REE was significantly increased in the patients with CF compared with healthy children (119.3 ± 3.1% predicted versus 103.6 ± 5% predicted, P < 0.001) and, using multiple regression techniques, REE for total body potassium was significantly increased in patients with CF (P = 0.0001). There was no relation between REE and nutritional status or pulmonary disease status in the CF group. In conclusion, REE is increased in children and adolescents with CF but is not directly related to nutritional status or pulmonary disease.
Nutritional status of children with cystic fibrosis measured by total body potassium as a marker of body cell mass: Lack of sensitivity of anthropometric measures
2000, Journal of Pediatrics
Objective: To investigate measures aimed at defining the nutritional status of cystic fibrosis (CF) populations, this study compared standard anthropometric measurements and total body potassium (TBK) as indicators of malnutrition. Methods: Height, weight, and TBK measurements of 226 children with CF from Royal Children’s Hospital, Brisbane, Australia, were analyzed. Z scores for height for age, weight for age, and weight for height were analyzed by means of the National Centre for Health Statistics reference. TBK was measured by means of whole body counting and compared with predicted TBK for age. Two criteria were evaluated with respect to malnutrition: (1) a z score < –2.0 and (2) a TBK for age <80% of predicted. Results: Males and females with CF had lower mean height-for-age and weight-for-age z scores than the National Centre for Health Statistics reference (P < .01), but mean weight-for-height z score was not significantly different. There were no significant gender differences. According to anthropometry, only 7.5% of this population were underweight and 7.6% were stunted. However, with TBK as an indicator of nutritional status, 29.9% of males and 22.0% of females were malnourished. Conclusion: There are large differences in the percentage of patients with CF identified as malnourished depending on whether anthropometry or body composition data are used as the nutritional indicator. At an individual level, weight-based indicators are not sensitive indicators of suboptimal nutritional status in CF, significantly underestimating the extent of malnutrition. Current recommendations in which anthropometry is used as the indicator of malnutrition in CF should be revised. (J Pediatr 2000;136:188-94)
Cystic fibrosis: Nutritional consequences and management
1998, Bailliere's Clinical Gastroenterology
Malnutrition is an adverse prognostic factor in cystic fibrosis, influencing the course of pulmonary disease and correlating inversely with survival. A positive energy balance between energy intake and the combination of total energy expenditure, energy losses and growth-related energy cost is essential to maintain normal nutritional status. Before starting nutritional supplementation, it is important to rule out pathological conditions that may have a deleterious effect on nutritional status: persistent exocrine pancreatic insufficiency, chronic bacterial pulmonary colonization, impaired glucose tolerance, specific nutritional deficits and associated disorders leading to a decrease of energy intake. Several methods are available, ranging from boosted oral nutrition to behavioural intervention, oral supplementation, enteral nutrition and, rarely, parenteral nutrition. The use of elemental nutrients for either oral supplementation or enteral nutrition seems of no nutritional benefit and is more expensive than conventional polymeric nutrients. Provided that the goals of the nutritional supplementation are fulfilled, simpler is often better.
Resting energy expenditures in Asian women measured by indirect calorimetry are lower than expenditures calculated from prediction equations
1997, Journal of the American Dietetic Association
Objective Measured resting energy expenditure (REE) and REEs calculated using the Harris-Benedict equation, Food and Agriculture Organization/World Health Organization/ United Nations University (FAO/WHO/UNU) equations (FAO equations), and the Liu equation were compared in Asian women.
Design REEs were measured using indirect calorimetry in the morning after an overnight fast and compared with REEs calculated using the Harris-Benedict equation, the FAO equations, and the Liu equation. Height, weight, and 3-day diet records were also obtained.
Subjects Thirty-six healthy, free-living Asian women aged 19 to 52 years and living in the United States were recruited from Washington State University, Pullman, and completed the study.
Statistical analyses Paired t tests, stepwise regression, one-way analysis of variance, and Pearson correlation coefficients were used for the statistical analyses. Significance was set at P≤.05.
Results A significant correlation was found between measured REE and REE derived from the Harris-Benedict equation (R=0.67, P<.0001), the FAO equations (R=0.70, P<.0001), and the Liu equation (R=0.70, P<.0001). However, measured REE was significantly lower than REE calculated using the Harris-Benedict and FAO equations by 8.5% (P<.001) and 5.4% (P<.01), respectively. No significant difference was noted between measured REE and REE derived from the Liu equation.
Applications Caution must be taken when predicting REE of Asian women using the Harris-Benedict equation or the FAO equation. Indirect calorimetry or an equation specific to Asians, such as the Liu equation, is recommended when an accurate estimate is necessary. J Am Diet Assoc. 1997; 97:1288-1292.

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Resting Energy Expenditures Measured by Indirect Calorimetry are Higher In Preadolescent Children with Cystic Fibrosis than Expenditures Calculated from Prediction Equations

Abstract

Section snippets

Subjects

Results

Discussion

Applications

J Am Diet Assoc.

J Pediatr.

J Am Diet Assoc.

Am J Clin Nutr.

Lancet

J Pediatr.

Chest.

Am J Clin Nutr.

Am J Clin Nutr.

Am J Clin Nutr.

J Pediatr.

Cystic fibrosis of the pancreas and its relation to celiac diseasea clinical and pathologic study

Am J Dis Child.

Abnormal electrolyte composition of sweat in cystic fibrosis of the pancreasclinical significance and relationship to the disease

Pediatrics.

Nutrition support in cystic fibrosis

Nutr Rev.

Textbook of Cystic Fibrosis

A rational approach to meeting macro- and micronutrient needs in cystic fibrosis

J Pediatr Gastroenterol Nutr.