1 Department of Clinical Dietetics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
2 Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2017 Sep;41(7):1195-1201. doi: 10.1177/0148607116658761. Epub 2016 Jul 12.
The mainstay of treatment for pediatric nonalcoholic fatty liver disease (NAFLD) is lifestyle modification, which includes dietary changes that lead to slow but sustained weight loss or weight stabilization in growing children. Accurate estimation of energy requirements is necessary to achieve this goal. The objective of this study was to assess the accuracy of the most commonly used equations in predicting the resting energy expenditure (REE) of children with NAFLD.
This was a retrospective study performed in a single institution. The predictive accuracy of various equations was assessed by comparing their estimates against the measured REE obtained with indirect calorimetry. Accuracy was defined as an estimate within 10% of measured REE.
Fifty-six children (70% male; 52% white and 36% Asian) with a median age of 13 years were included. The median measured REE was 1829 kcal/d. Of the equations studied, the Schofield had the smallest average bias (-32 kcal/d; confidence interval, -121 to 56). The Schofield and Molnar equations were the most accurate, providing REE estimates within 10% of measured in 59% of cases. The remaining equations had lower and variable predictive accuracy. The use of adjusted body weight in predictive equations did not improve the predictive accuracy.
In a cohort of children and adolescents with NAFLD, the Schofield and Molnar equations performed best in predicting energy expenditure. However, predictive equations were often inaccurate, suggesting that clinicians should interpret their results with caution and consider using indirect calorimetry when available.
儿科非酒精性脂肪性肝病（NAFLD）的主要治疗方法是生活方式改变，包括导致生长中儿童缓慢但持续减重或体重稳定的饮食变化。准确估计能量需求是实现这一目标的必要条件。本研究的目的是评估最常用于预测 NAFLD 儿童静息能量消耗（REE）的方程的准确性。
这是一项在单一机构进行的回顾性研究。通过将各种方程的估计值与间接测热法获得的测量 REE 进行比较，评估其预测准确性。准确性定义为估计值与测量 REE 的差值在 10%以内。
共纳入 56 名儿童（70%为男性；52%为白人，36%为亚洲人），中位年龄为 13 岁。测量的 REE 中位数为 1829 千卡/天。在所研究的方程中，Schofield 方程的平均偏差最小（-32 千卡/天；置信区间，-121 至 56）。Schofield 和 Molnar 方程最准确，59%的情况下提供的 REE 估计值在测量值的 10%以内。其余方程的预测准确性较低且变化较大。在预测方程中使用调整后的体重并不能提高预测准确性。
在一组患有 NAFLD 的儿童和青少年中，Schofield 和 Molnar 方程在预测能量消耗方面表现最佳。然而，预测方程往往不准确，这表明临床医生在解释结果时应谨慎，并在有条件时考虑使用间接测热法。
