Anderegg Brent A, Worrall Cathy, Barbour English, Simpson Kit N, Delegge Mark
Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
JPEN J Parenter Enteral Nutr. 2009 Mar-Apr;33(2):168-75. doi: 10.1177/0148607108327192.
Several methods are available to estimate caloric needs in hospitalized, obese patients who require specialized nutrition support; however, it is unclear which of these strategies most accurately approximates the caloric needs of this patient population. The purpose of this study was to determine which strategy most accurately predicts resting energy expenditure in this subset of patients.
Patients assessed at high nutrition risk who required specialized nutrition support and met inclusion and exclusion criteria were enrolled in this observational study. Adult patients were included if they were admitted to a medical or surgical service with a body mass index > or = 30 kg/m(2). Criteria excluding patient enrollment were pregnancy and intolerance or contraindication to indirect calorimetry procedures. Investigators calculated estimations of resting energy expenditure for each patient using variations on the following equations: Harris-Benedict, Mifflin-St. Jeor, Ireton-Jones, 21 kcal/kg body weight, and 25 kcal/kg body weight. For nonventilated patients, the MedGem handheld indirect calorimeter was used. For ventilated patients, the metabolic cart was used. The primary endpoint was to identify which estimation strategy calculated energy expenditures to within 10% of measured energy expenditures.
The Harris-Benedict equation, using adjusted body weight with a stress factor, most frequently estimated resting energy expenditure to within 10% measured resting energy expenditure at 50% of patients.
Measured energy expenditure with indirect calorimetry should be employed when developing nutrition support regimens in obese, hospitalized patients, as estimation strategies are inconsistent and lead to inaccurate predictions of energy expenditure in this patient population.
对于需要特殊营养支持的住院肥胖患者，有多种方法可用于估算热量需求；然而，尚不清楚这些策略中哪一种最能准确地估算该患者群体的热量需求。本研究的目的是确定哪种策略能最准确地预测该亚组患者的静息能量消耗。
本观察性研究纳入了评估为高营养风险、需要特殊营养支持且符合纳入和排除标准的患者。如果成年患者因医疗或外科疾病入院，且体重指数≥30kg/m²，则纳入研究。排除患者入组的标准包括妊娠以及对间接测热法程序不耐受或有禁忌证。研究人员使用以下公式的变体计算每位患者的静息能量消耗估计值：哈里斯-本尼迪克特公式、米夫林-圣乔尔公式、艾尔顿-琼斯公式、21千卡/千克体重和25千卡/千克体重。对于未通气的患者，使用MedGem手持式间接测热仪。对于通气的患者，使用代谢车。主要终点是确定哪种估计策略计算出的能量消耗在测量能量消耗的10%以内。
使用带有应激因素的调整体重的哈里斯-本尼迪克特公式，在50%的患者中，最常将静息能量消耗估计在测量静息能量消耗的10%以内。
在为肥胖住院患者制定营养支持方案时，应采用间接测热法测量能量消耗，因为估计策略不一致，会导致对该患者群体能量消耗的预测不准确。
