Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, British Columbia, Canada; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
Am J Clin Nutr. 2024 Nov;120(5):1071-1084. doi: 10.1016/j.ajcnut.2024.08.023. Epub 2024 Aug 28.
Energy requirement assessment is a cornerstone for nutrition practice. The extent to which total energy expenditure (TEE; indicator of energy requirements) has been measured in adults with chronic diseases has not been explored.
This systematic review aimed to characterize evidence on TEE among individuals with chronic diseases and describe TEE across chronic diseases and in comparison to controls without a chronic disease.
A literature search using terms related to doubly labeled water and TEE was conducted in PubMed, MEDLINE, Web of Science, and Embase. Eligible articles included those that measured TEE using doubly labeled water in adults with a major chronic disease. Methodological quality was determined using the Academy of Nutrition and Dietetics quality criteria checklist. Sample size-weighted TEE was calculated in each chronic disease subgroup.
Fifty studies were included, of which 15 had a control group. Median sample size was 20 participants, and approximately half of studies were published over 10 y ago. Thirty-five (70%) studies reported resting energy expenditure, and approximately half (k = 26) reported physical activity level. Methodological quality was neutral (k = 25) or positive (k = 23) for most studies. TEE among individual studies ranged from 934 to 3274 kcal/d. Mean weighted TEE was lowest among gastrointestinal (1786 kcal/d) and neurologic (2104 kcal/d) subgroups and highest among cancer (2903 kcal/d), endocrine (2661 kcal/d), and autoimmune (2625 kcal/d) subgroups. Excluding 1 article in cancer survivors resulted in a low TEE in the cancer subgroup (2112 kcal/d). Most studies with a control group reported no differences in TEE between controls and patients; however, only 1 study was powered for between-group comparisons.
Energy requirements vary across chronic diseases, although there is insufficient evidence to suggest that TEE in patients with chronic disease is different than that among controls. Further research is needed to inform energy requirement recommendations that consider chronic disease. This review was registered at PROSPERO as CRD42022336500 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336500).
能量需求评估是营养实践的基石。尚未探讨患有慢性疾病的成年人中总能量消耗（TEE；能量需求的指标）的测量程度。
本系统评价旨在描述患有慢性疾病的个体中 TEE 的证据，并描述 TEE 在各种慢性疾病中的情况，并与没有慢性疾病的对照进行比较。
使用与双标水和 TEE 相关的术语，在 PubMed、MEDLINE、Web of Science 和 Embase 中进行文献检索。符合条件的文章包括使用双标水测量成年人主要慢性疾病患者 TEE 的文章。使用营养与饮食学会质量标准检查表确定方法学质量。在每个慢性疾病亚组中计算样本量加权 TEE。
共纳入 50 项研究，其中 15 项研究有对照组。中位样本量为 20 名参与者，约一半的研究发表于 10 年前。35 项（70%）研究报告了静息能量消耗，约一半（k = 26）研究报告了体力活动水平。大多数研究的方法学质量为中性（k = 25）或阳性（k = 23）。个别研究中的 TEE 范围为 934 至 3274 千卡/天。加权平均 TEE 在胃肠道（1786 千卡/天）和神经（2104 千卡/天）亚组中最低，在癌症（2903 千卡/天）、内分泌（2661 千卡/天）和自身免疫（2625 千卡/天）亚组中最高。排除 1 项癌症幸存者研究后，癌症亚组的 TEE 较低（2112 千卡/天）。大多数有对照组的研究报告称，对照组和患者之间的 TEE 没有差异；然而，只有 1 项研究是针对组间比较进行的。
尽管没有足够的证据表明患有慢性疾病的患者的 TEE 与对照组不同，但慢性疾病之间的能量需求存在差异。需要进一步研究为考虑慢性疾病的能量需求建议提供信息。本综述在 PROSPERO 上注册为 CRD42022336500（https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336500）。
