Mogensen Kris M, Andrew Benjamin Y, Corona Jasmine C, Robinson Malcolm K
Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts Duke University School of Medicine, Durham, North Carolina.
JPEN J Parenter Enteral Nutr. 2016 Jul;40(5):713-21. doi: 10.1177/0148607115584001. Epub 2015 Apr 20.
The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) recommend that obese, critically ill patients receive 11-14 kcal/kg/d using actual body weight (ABW) or 22-25 kcal/kg/d using ideal body weight (IBW), because feeding these patients 50%-70% maintenance needs while administering high protein may improve outcomes. It is unknown whether these equations achieve this target when validated against indirect calorimetry, perform equally across all degrees of obesity, or compare well with other equations.
Measured resting energy expenditure (MREE) was determined in obese (body mass index [BMI] ≥30 kg/m(2)), critically ill patients. Resting energy expenditure was predicted (PREE) using several equations: 12.5 kcal/kg ABW (ASPEN-Actual BW), 23.5 kcal/kg IBW (ASPEN-Ideal BW), Harris-Benedict (adjusted-weight and 1.5 stress-factor), and Ireton-Jones for obesity. Correlation of PREE to 65% MREE, predictive accuracy, precision, bias, and large error incidence were calculated.
All equations were significantly correlated with 65% MREE but had poor predictive accuracy, had excessive large error incidence, were imprecise, and were biased in the entire cohort (N = 31). In the obesity cohort (n = 20, BMI 30-50 kg/m(2)), ASPEN-Actual BW had acceptable predictive accuracy and large error incidence, was unbiased, and was nearly precise. In super obesity (n = 11, BMI >50 kg/m(2)), ASPEN-Ideal BW had acceptable predictive accuracy and large error incidence and was precise and unbiased.
SCCM/ASPEN-recommended body weight equations are reasonable predictors of 65% MREE depending on the equation and degree of obesity. Assuming that feeding 65% MREE is appropriate, this study suggests that patients with a BMI 30-50 kg/m(2) should receive 11-14 kcal/kg/d using ABW and those with a BMI >50 kg/m(2) should receive 22-25 kcal/kg/d using IBW.
危重病医学会（SCCM）和美国肠外肠内营养学会（ASPEN）建议，肥胖的危重病患者按实际体重（ABW）计算每日摄入11 - 14千卡/千克，或按理想体重（IBW）计算每日摄入22 - 25千卡/千克，因为在给予高蛋白的同时，让这些患者摄入维持需求的50% - 70%可能会改善预后。当根据间接测热法进行验证时，这些公式是否能达到这一目标，在所有肥胖程度的患者中表现是否相同，或者与其他公式相比是否良好，目前尚不清楚。
测定肥胖（体重指数[BMI]≥30 kg/m²）危重病患者的实测静息能量消耗（MREE）。使用多个公式预测静息能量消耗（PREE）：12.5千卡/千克ABW（ASPEN - 实际体重）、23.5千卡/千克IBW（ASPEN - 理想体重）、哈里斯 - 本尼迪克特公式（校正体重和1.5的应激系数）以及针对肥胖患者的艾尔顿 - 琼斯公式。计算PREE与65% MREE的相关性以及预测准确性、精密度、偏差和大误差发生率。
所有公式与65% MREE均显著相关，但预测准确性较差，大误差发生率过高，不精确，且在整个队列（N = 31）中存在偏差。在肥胖队列（n = 20，BMI 30 - 50 kg/m²）中，ASPEN - 实际体重具有可接受的预测准确性和大误差发生率，无偏差，且近乎精确。在超级肥胖队列（n = 11，BMI > 50 kg/m²）中，ASPEN - 理想体重具有可接受的预测准确性和大误差发生率，精确且无偏差。
根据公式和肥胖程度，SCCM/ASPEN推荐的体重公式是65% MREE的合理预测指标。假设摄入65% MREE是合适的，本研究表明，BMI为30 - 50 kg/m²的患者应按ABW计算每日摄入11 - 14千卡/千克，BMI > 50 kg/m²的患者应按IBW计算每日摄入22 - 25千卡/千克。
