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REE predictive equations inaccurate for preventing malnutrition in pediatric ESLD

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Equations used to predict resting energy expenditure in infants and children with end-stage liver disease listed for liver transplantation were inaccurate compared with indirect calorimetry for determining optimal nutrition intake, according to data presented at ASPEN Clinical Nutrition Week.

Aiming to evaluate the accuracy of commonly used predictive equations for resting energy expenditure (REE) in pediatric patients with end-stage liver disease (ESLD), researchers from the Hospital for Sick Children in Toronto retrospectively reviewed the medical charts of 31 children (51% boys) listed for liver transplantation between June 2013 and July 2014. They compared REE measured using indirect calorimetry (their program protocol during the time period) with REE calculated using the Food and Agriculture Organization/WHO/United Nations University (FAO/WHO/UNU), Schofield weight and height and Schofield weight equations.

Median REE measured with indirect calorimetry was 15% higher compared with REE predicted by the FAO/WHO/UNU equation (range, 46% lower to 99% higher). The FAO/WHO/UNU equation underestimated REE by 63 ± 370 kcal/day on average (P = .023) and accurately estimated REE (± 10% of measured) in only 13% of patients.

Median REE measured with indirect calorimetry was 10% lower compared with REE predicted by the Schofield weight and height equation (range, 70% lower to 40% higher) and 40% lower compared with REE estimated by the Schofield weight equation (range, 80% lower to 20% higher). Both Schofield equations respectively overestimated REE by 66 ± 173 kcal/day and 243 ± 232 kcal/day on average (P = .041), and only 6% and 10% of their estimates were within 10% of measured REE, respectively.

The researchers concluded that equations to predict REE should not be used to guide energy provision to pediatric patients listed for liver transplantation due to their inaccuracy, and should instead be measured using indirect calorimetry to optimize nutritional intake recommendations and reduce malnutrition-associated morbidity and mortality. – by Adam Leitenberger 

Reference:

Mouzaki M, et al. Abstract 7. Presented at: ASPEN Clinical Nutrition Week; Feb. 14-17, 2015; Long Beach, Calif.

Disclosure: The researchers report no relevant financial disclosures.