Bøgedal Pape Mie Kristine, Hyldgaard Louise, Stentoft Gustav Wedding, Valbirk William Kasper, Toftgård Toke Tinø, Magdalena Andås Ella Ottilia, Køhler Marianne, Rasmussen Henrik Højgaard, Mikkelsen Sabina, Holst Mette
Department of Health, Science and Technology, Aalborg University, Denmark.
Department of Gastroenterology, Center for Nutrition and Intestinal Failure and Danish Nutrition Science Centre, Aalborg University Hospital, Søndre Skovvej 5, 9000 Aalborg, Denmark.
Clin Nutr ESPEN. 2025 Apr;66:505-514. doi: 10.1016/j.clnesp.2025.02.009. Epub 2025 Feb 24.
BACKGROUND & AIMS: Methods for estimation of nutritional expenditures for hospitalized patients may not be sufficiently specific. This study aimed to investigate the accuracy of predictive equations compared to indirect calorimetry (IC) and the effect of certain patient characteristics which might correlate with total daily energy expenditure on a heterogeneous population of hospitalized medical patients.
A cross sectional study including demographic information, measures of bioelectric impedance analysis (BIA) including height and bodyweight (BW), IC, heart rate and from patient records, information was collected regarding nutritional risk by Nutrition Risk Screening 2002, biomarkers of C-reactive protein (CRP), albumin and leukocytes. The Harris-Benedict (HB), Mifflin St. Jeor (MSJ), and Schofield equations were calculated. Data were analyzed using T-test, linear and logistic regression analysis.
Overall, 197 patients, mean age 63.6 ± 16.0 years were measured with IC and had equations performed. BIA was performed in 187 and 46 withdrew, as they were too ill to measure, has oxygen or forgot fasting. All estimation methods underestimate energy expenditures for patients at nutritional risk (p < 0.001), and HB and MSJ underestimate for those with body mass index (BMI) < 18.5 (p = 0.029 and p < 0.001), while for BMI≥30 all overestimate but only HB significantly (p = 0.025). Elevated CRP and leukocytes, lower heart rate, lower and higher BMI, older patients and patients at nutritional risk can affect estimated total daily energy expenditure by equations compared measured by IC (p < 0.05).
HB, MSJ, and Schofield equations all underestimate energy expenditures with higher variations in patients at nutritional risk. In patients with BMI≥30, energy expenditures are overestimated. Considerations are to measure energy expenditures for patients at nutritional risk with continued weight loss and need for artificial nutrition, and for those with BMI≥30.
估算住院患者营养支出的方法可能不够具体。本研究旨在调查预测方程与间接测热法（IC）相比的准确性，以及某些可能与住院内科患者异质性群体的每日总能量消耗相关的患者特征的影响。
一项横断面研究，收集人口统计学信息、生物电阻抗分析（BIA）测量值（包括身高和体重（BW））、IC、心率，并从患者记录中收集关于通过2002年营养风险筛查得出的营养风险、C反应蛋白（CRP）、白蛋白和白细胞的生物标志物的信息。计算哈里斯-本尼迪克特（HB）、米夫林-圣乔尔（MSJ）和斯科菲尔德方程。使用t检验、线性和逻辑回归分析对数据进行分析。
总体而言，对197例平均年龄为63.6±16.0岁的患者进行了IC测量并计算了方程。187例患者进行了BIA，46例因病情过重无法测量、吸氧或忘记禁食而退出。所有估算方法均低估了有营养风险患者的能量消耗（p<0.001），对于体重指数（BMI）<18.5的患者，HB和MSJ方程低估了能量消耗（p=0.029和p<0.001），而对于BMI≥于30的患者，所有方程均高估了能量消耗，但只有HB方程有显著差异（p=0.025）。与IC测量值相比，CRP和白细胞升高、心率降低、BMI降低和升高、老年患者以及有营养风险的患者会影响方程估算的每日总能量消耗（p<0.05）。
HB、MSJ和斯科菲尔德方程均低估了能量消耗，在有营养风险的患者中差异更大。对于BMI≥30的患者，能量消耗被高估。对于持续体重减轻且需要人工营养的有营养风险患者以及BMI≥30的患者，应考虑测量其能量消耗。
