Thomson M A, Bucolo S, Quirk P, Shepherd R W
Department of Child Health, Royal Children's Hospital, Brisbane, Australia.
J Pediatr. 1995 Jan;126(1):21-7. doi: 10.1016/s0022-3476(95)70494-9.
The reliability of commonly used predictive equations for estimating energy expenditure in infants in both health and disease was assessed by comparing resting energy expenditure (REE, measured by indirect calorimetry) in relation to weight, height, and body cell mass (by total body potassium analysis) with predictive equations (Harris-Benedict, Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield weight-only, and Schofield weight-and-height equations) in 36 healthy infants (age 0.43 +/- 0.27 years; 19 male) and in 9 infants with cystic fibrosis (age 0.41 +/- 0.30 years; 4 male). Mean +/- SD REE for healthy boys was 0.205 +/- 0.019 MJ kg-1 day-1 and for healthy girls 0.217 +/- 0.026 MJ kg-1 day-1. Infants with cystic fibrosis had a significantly higher REE (0.258 +/- 0.034 vs 0.210 +/- 0.024 MJ kg-1 day-1; p < 0.005). Compared with measured values, predicted REE values varied markedly among equations, overestimating REE in healthy infants (Harris-Benedict equation, 182% +/- 63% (SD) of measured values; FAO/WHO/UNU equation, 104% +/- 14%; Schofield weight-only equation, 107.5% +/- 14%; and Schofield weight-and-height equation, 106% +/- 11%) and underestimating REE in those with cystic fibrosis (84% to 88% for the FAO/WHO/UNU, Schofield weight-only, and Schofield weight-and-height equations) except the Harris-Benedict equation (152%). On regression analysis both weight and body cell mass were related significantly to REE (r2 = 0.87 and r2 = 0.61, respectively) for normal infants and (r2 = 0.92 and r2 = 0.94) for those with cystic fibrosis. Using a generalized linear model of variance, we saw a significant (p < 0.001) variability among all REE measures. Thus we could rely on none of the predictive equations to give an accurate estimate of REE, and hence energy and fluid requirements, in individual infants. We suggest that when accurate estimates are needed, measurement of REE in individual infants should be attempted, especially in disease states, and that the continued use of current formulas should be reexamined.
通过比较36名健康婴儿（年龄0.43±0.27岁；19名男性）和9名囊性纤维化婴儿（年龄0.41±0.30岁；4名男性）的静息能量消耗（REE，通过间接量热法测量）与体重、身高和身体细胞质量（通过全身钾分析），评估常用预测方程在估计健康和患病婴儿能量消耗方面的可靠性。所使用的预测方程包括哈里斯-本尼迪克特方程、联合国粮食及农业组织/世界卫生组织/联合国大学（FAO/WHO/UNU）方程、仅基于体重的斯科菲尔德方程以及基于体重和身高的斯科菲尔德方程。健康男婴的平均±标准差REE为0.205±0.019兆焦·千克⁻¹·天⁻¹，健康女婴为0.217±0.026兆焦·千克⁻¹·天⁻¹。囊性纤维化婴儿的REE显著更高（0.258±0.034对0.210±0.024兆焦·千克⁻¹·天⁻¹；p<0.005）。与测量值相比，各方程预测的REE值差异显著，健康婴儿中存在高估（哈里斯-本尼迪克特方程，测量值的182%±63%（标准差）；FAO/WHO/UNU方程，104%±14%；仅基于体重的斯科菲尔德方程，107.5%±14%；基于体重和身高的斯科菲尔德方程，106%±11%），而囊性纤维化婴儿中存在低估（FAO/WHO/UNU、仅基于体重的斯科菲尔德方程和基于体重和身高的斯科菲尔德方程为84%至88%），哈里斯-本尼迪克特方程除外（152%）。回归分析显示，正常婴儿的体重和身体细胞质量均与REE显著相关（r²分别为0.87和0.61），囊性纤维化婴儿的体重和身体细胞质量与REE的相关性更强（r²分别为0.92和0.94）。使用广义线性方差模型，我们发现所有REE测量值之间存在显著差异（p<0.001）。因此，我们无法依靠任何一个预测方程来准确估计个体婴儿的REE，进而无法准确估计能量和液体需求。我们建议，当需要准确估计时，应尝试测量个体婴儿的REE，尤其是在疾病状态下，并且应重新审视当前公式的持续使用情况。
