Resting energy expenditure in interstitial lung disease

Because interstitial lung disease increases the work of breathing, the aim of this study was to determine if this condition is associated with increased energy requirements. A group of 12 clinically stable patients with interstitial lung disease was studied. Patients with a history of weight loss had significantly more severe lung volume restriction. Regression analysis showed that 42% of body weight variation was explained by vital capacity (p less than 0.025). Resting energy expenditure was measured by standard methods of indirect calorimetry. The measurements were performed with a ventilated hood during prolonged steady-state periods after an overnight fast. We found that resting energy expenditure was increased to 117.3 and 118.7% of the predicted basal metabolic rate, according to Fleisch and to Harris and Benedict reference values, respectively (p less than 0.001). Furthermore, resting energy expenditure was increased to 120.8% of the predicted value according to body fat-free mass (p less than 0.001). This extra energy expenditure in patients with interstitial lung disease is similar to that recently reported in patients with chronic obstructive pulmonary disease.     

Resting energy expenditure during hemodialysis

Very few studies have so far reported about resting energy expenditure (REE) in chronic renal failure and there is no information available on REE during hemodialysis (HD). Hypothetically, we can expect an increase in REE during HD procedure (due to the inflammatory response to extracorporeal blood circuit). However, such increase in REE could be modified by thermal balance of the procedure. In our study, REE was measured by indirect calorimetry (Deltatrac Datex) in a group of 13 HD patients (7 males and 6 females, mean age 59.8 +/- 13.5 years). In each patient, REE was assessed during two HD sessions: one isothermic and one thermoneutral. All other HD parameters were kept constant. The control group consisted of 14 healthy subjects (4 males and 10 females, mean age 41.3 +/- 20.5 years) with normal renal function. There was a significant difference in thermal balance between the two HD settings: -199 kJ/HD in isothermic and -4kJ/HD in thermoneutral HD sessions (p < 0.01). Measured REE values obtained in HD patients before HD session (7 316 +/- 919 kJ/day/1.73 m2) did not differ significantly from those of the healthy controls (7 264 +/- 1 016 kJ/day/1.73 m2). Similarly, there was no significant difference in calculated EE values (Harris-Benedict equation). In the 10th minute of the HD session, there was a slight, transitory decrease in REE (mean decrease by 3.2% during isothermic and by 2.8% during thermoneutral HD session, ns). In the 70th minute, REE returned to pre-dialysis values. After a light meal in the 110th minute REE increased by 8% during isothermic and by 6.3% during thermoneutral HD session. At the end of the HD session (i.e. in the 215th minute) REE again returned to pre-dialysis values. Intra-dialysis changes in REE were similar in both isothermic and thermoneutral HD sessions. The results of our study did not confirm the expected influence of HD procedure on REE in the two different thermal HD settings. We conclude that there is no significant difference between REE in HD patients and healthy controls and that REE values are not significantly influenced by hemodialysis procedure.     

Resting energy expenditure in short-stature children

It is not clear what dietary intake standards should be used for children with abnormal body size. To investigate the energy requirements of short-stature children with no underlying diseases, their resting energy requirements (REE) were measured by indirect calorimetry. The short-stature group consisted of 30 prepubertal children with short stature and with no underlying diseases (age 6y±2) and the control group consisted of 13 age-matched children with standard stature. Fasting REE and the respiration quotient (RQ) with subjects in the supine position were measured by canopy indirect calorimetry. Actual measurements and body-size-adjusted REEs were compared between the groups. Also, REE measurements were compared with the basal metabolic rate (BMR) calculated using the Dietary Reference Intakes for Japanese (Dietary Reference Intakes). REE in the control group was significantly higher than that in the short-stature group. However, body-size-adjusted REEs were significantly higher for the short-stature group. When the actual REE was compared with the calculated BMR within both the control group and the short-stature group, which was acquired using the Dietary Reference Intakes, there was no difference within the control group but the actual REE measurements were significantly higher than the calculated BMR in the short-stature group. The same pattern was seen within the short-stature group when subjects were matched for height. There were no significant differences in RQ between the two groups.     

Resting energy expenditure in chronic hepatitis C

BACKGROUND/AIMS: Hypermetabolism is considered to be of clinical interest in liver disease and in several chronic viral infections. Whether resting energy expenditure (REE) increases during chronic hepatitis C is not known. Our aims were: (a) to determine the metabolic state of patients with chronic hepatitis C, and (b) to evaluate the effects of interferon therapy on REE. METHODS: Forty-seven patients and 20 controls were studied. Sixteen patients failed to respond to interferon and 12 patients stopped the treatment during the first 2 months for various reasons. The 19 responders all received 1 year of interferon. REE (indirect calorimetry) and fat-free mass (FFM, bioelectric impedance analysis) were evaluated before (day 0) and after 90, 180, and 360 days of interferon. The virus load was evaluated in patients before treatment. RESULTS: On day 0, REE expressed as a ratio of FFM (REE/FFM) was higher in patients than in controls (129.2 +/- 14.7 vs 117.9 +/- 9.6 kJ kg FFM(-1) 24 h(-1), p<0.01), and was positively correlated with the viral load (r=0.45, p=0.01). On day 90, REE/FFM had significantly decreased in responders but it did not decrease in non-responders (p<0.01). In responders, REE/FFM on days 180 and 360 was similar to that of the controls. CONCLUSIONS: Chronic hepatitis C induces hypermetabolism that is normalized by interferon therapy in responders. The underlying mechanisms of chronic hepatitis C-induced hypermetabolism and its clinical relevance remain to be determined.     

Resting energy expenditure and body composition in pediatric HIV infection

One of the most striking features of HIV disease is the "wasting syndrome" or failure to thrive. Eighty percent of all perinatally HIV-infected children fail to grow normally. OBJECTIVE. Because severe malnutrition increases the morbidity of HIV infection and may shorten the already limited life expectancy of this population, we assessed resting energy needs, body composition, and nutrient intake in nine children perinatally HIV-infected, age 4 months to 4 years. DESIGN. Subjects were studied using measurements of resting energy expenditure (REE) by indirect calorimetry, body composition measurements by dual-energy X-ray absorptiometry (DEXA) and skinfolds, nutrient intake analysis by 24-hour recall, and serum protein levels. The HIV-infected children were free of secondary opportunistic infection at the time of the study. Subjects were reevaluated within the following year. RESULTS. REE correlated well (r = .856) with the predicted value from the World Health Organization (WHO) equation for basal energy expenditure. Measurement of percent body fat by skinfolds correlated well with DEXA percent body fat (r = .61). There was no significant difference between body fat assessed from skinfolds compared to published age-matched standards. All subjects met their recommended dietary allowance (RDA) for calories and protein. All subjects had adequate visceral protein stores for age. CONCLUSION. Perinatally infected children were not hypermetabolic when not secondarily infected and were able to maintain normal growth with the provision of adequate nutrition.     

Resting energy expenditure in subjects with and without intermittent claudication

Subjects with peripheral arterial disease and intermittent claudication have ischemia of the lower extremities, but little is known how this influences resting energy expenditure. The objective of the study was to compare the resting energy expenditure of subjects with and without intermittent claudication. One hundred six subjects limited by intermittent claudication and 77 controls who did not have peripheral arterial disease and intermittent claudication participated in this study. Subjects were assessed on resting energy expenditure, body composition, ankle/brachial index (ABI), and calf blood flow. Subjects with intermittent claudication had a lower resting energy expenditure (1585 ± 251 vs 1716 ± 277 kcal/d, P = .019), higher body fat percentage (33.4% ± 10.7% vs 29.6% ± 7.7%, P = .016), higher fat mass (29.6 ± 10.6 vs 24.2 ± 8.9 kg, P = .011), and lower ABI (0.66 ± 0.20 vs 1.19 ± 0.12, P < .001). Resting energy expenditure was predicted by fat-free mass (P < .001), ABI (P = .027), and calf blood flow (P = .040). Resting energy expenditure remained lower in the subjects with intermittent claudication after adjusting for clinical characteristics plus fat-free mass (1611 ± 171 vs 1685 ± 209 kcal/d, P = .035), but was no longer different between groups after further adjustment for ABI and calf blood flow (1622 ± 165 vs 1633 ± 185 kcal/d, P = .500). Subjects with intermittent claudication have lower resting energy expenditure than controls, which is partially explained by ABI and calf blood flow.     

Resting energy expenditure in patients with alcoholic chronic pancreatitis

The aim of this study was to assess resting energy expenditure in patients with chronic pancreatitis; 33 patients with alcohol-related chronic pancreatitis (group 1: 13 normal weight, group 2: 20 underweight) and 11 undernourished patients without identifiable disease (group 3) were studied. Body composition was determined by bioelectric impedance analysis and energy expenditure by indirect calorimetry. The percentage of body weight occupied by fat-free mass was similar among the three groups (76.4±1.5%, 78.6±1.3% and 76.8±2.1% for groups 1, 2, and 3, respectively). The measured resting energy expenditure (REE) was higher than the predicted EE (Harris and Benedict formula and Cunningham's equation) for the underweight patients with chronic pancreatitis (group 2) (P<0.05), but not for the two other groups. According to Cunningham's equation, 65% of the group 2 patients were hypermetabolic (REE>110% of predicted EE) versus 23.1% and 20% in groups 1 and 3. When adjusted for fat free mass, REE was significantly (P<0.01) higher in group 2 (35.0±0.9 kcal/kg/24 hr) than in the other two groups (30.1±0.7 kcal/kg/24 hr and 30.8±1.4 kcal/kg/24 hr in groups 1 and 3, respectively). During chronic pancreatitis, weight loss is accompanied by hypermetabolism, which should be taken into consideration during nutritional support.     

Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma

BACKGROUND The diagnosis of malnutrition in patients with independent hepatocellular carcinoma(HCC)varies from 20%to 50%,is related to important complications and has a direct impact on the prognosis.Determination of the resting energy expenditure(REE)has become an important parameter in this population,as it allows therapeutic adjustments to recover their nutritional status.The REE in cirrhosis,with and without HCC,is not clearly defined,and requires the identification and definition of the best nutritional approach.AIM To evaluate the REE of patients with cirrhosis,with and without HCC.METHODS This is a prospective observational study evaluating the REE of 118 patients,33 with cirrhosis and hepatocellular carcinoma and a control group of 85 patients with cirrhosis without HCC,using indirect calorimetry(IC),bioimpedance,and predictive formulas.RESULTS The REE determined by IC in cirrhotic patients with HCC was 1643±364 and in those without HCC was 1526±277(P=0.064).The REE value as assessed by bioimpedance was 1529±501 for those with HCC and 1660±385 for those without HCC(P=0.136).When comparing the values of REE determined by IC and predictive formulas in cirrhotics with HCC,it was observed that only the formulas of the Food and Agriculture Organization(FAO)/World Health Organization(WHO)(1985)and Cunningham(1980)presented values similar to those determined by IC.When comparing the REE values determined by IC and predictive formulas in cirrhotics without HCC,it was observed that the formulas of Schofield(1985),FAO/WHO(1985),WHO(2000),Institute of Medicine(IOM)(2005)and Katch and McArdie(1996)presented values similar to those determined by IC.CONCLUSION The FAO/WHO formula(1985)could be used for cirrhotic patients with or without HCC;as it is the one with the values closest to those obtained by IC in these cirrhotic patients.     

Resting energy expenditure in uremic, diabetic, and uremic diabetic subjects

We compared Harris and Benedict [H & B; Harris, J. A., & Benedict, F. G. (1919). A biometric study of basal metabolism in man. Washington, DC: Carnegie Institution of Washington. p. 279.] predicted resting energy expenditure (REE) to values measured by indirect calorimetry in normal, uremic, diabetic, and uremic diabetic subjects. Predicted REE were overestimated (+9.2%, P<.005) in uremic subjects, and underestimated (-8.5%, P<.0001) in diabetic subjects. Uremic diabetic subjects were submitted to the opposite influences of diabetes and uremia on REE. Differences in body composition (lower fat-free mass in uremia and higher fat-free mass in diabetes) played a major role in these influences. In uremic diabetic subjects, predicted REE seemed well fitted to measured REE (biases <2%), but they were less correlated, and limits of agreement between predicted and measured REE were large. Although their mean REE seems normal, prediction by the H&B equation leads to important individual errors in uremic diabetic subjects: direct measurement of energy expenditure by indirect calorimetry may be helpful to precise the adequate energy content of a diet for these subjects.     

Resting energy expenditure in women: impact of obesity and body-fat distribution

Postabsorptive resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) were repeatedly assessed with an indirect calorimetric ventilated hood system in a group of 32 healthy premenopausal obese women, body fat percentage 46.4 +/- 0.9 (mean +/- SEM), age 38.5 +/- 0.9 years. RMR and DIT were also measured in a group of 10 healthy premenopausal non-obese women, body fat percentage 31.3 +/- 1.7, age 37.7 +/- 2.4 years. The obese women were subdivided according to the waist-to-hips girth ratio (WHR) into three groups with a different type of body fat distribution: A gluteal-femoral obese group (n = 10), WHR less than 0.79; an intermediate obese group (n = 10), 0.79 less than WHR less than 0.85; and an abdominal obese group (n = 12), WHR greater than 0.85. No significant differences were observed among the obese groups in age, body weight, body fat mass, and fat-free body mass. Body fat distribution was not associated with differences in DIT, pre- and postprandial respiratory quotients and substrate oxidation rates, but the abdominal obese women had significantly higher RMRs adjusted for age, fat mass, and fat-free body mass (6,075 +/- 200 kJ/d) in comparison with the gluteal-femoral obese women (5,502 +/- 205 kJ/d) and in comparison with obese women with an intermediate body fat distribution (5,517 +/- 193 kJ/d), but not in comparison with a non-obese control group, 6,790 +/- 261 kJ/d. It is concluded that within the total group of obese women, the non-abdominal obese can be characterized by relatively reduced resting metabolic rates in comparison with either the abdominal obese or with non-obese women.     

Resting energy expenditure in Duchenne patients using home mechanical ventilation.

Nutritional status is both important and difficult to assess in patients with Duchenne muscular dystrophy (DMD), particularly in those requiring mechanical ventilation (MV). The current authors evaluated body composition (bio-impedancemetry), resting energy expenditure (REE; indirect calorimetry) and energy intake in 20 adult patients with DMD using home MV (nocturnal: n = 13; continuous: n = 7) and 12 age-matched healthy controls. The patients were smaller in height than the controls and had a lower body weight. Most of the reduction in body mass index was accounted for by a reduction in fat free mass (FFM). REE (kJ) was significantly reduced in the patients (4559+/-853 kJ x 24 h(-1) versus 7407+/-1312 kJ x 24 h(-1)), but the difference disappeared after correction for FFM. REE and FFM were correlated in both the controls and patients, but less strongly in the latter, the lower strength of the association being due to the patients using continuous MV (REE and FFM uncorrelated). The food intake of the patients was 1.2+/-0.4 greater than their REE. This study shows that patients with advanced forms of Duchenne muscular dystrophy have balanced energy intakes and resting energy expenditure.     

Resting energy expenditure and nutritional status in children with juvenile rheumatoid arthritis.

OBJECTIVE: Undernutrition is frequently encountered in children with juvenile rheumatoid arthritis (JRA). We assessed resting energy expenditure (REE) in relation to nutritional status and body composition in patients with JRA. METHODS: We selected 33 children (age 6 to 18 yrs) with JRA (13 oligoarticular, 10 polyarticular, 10 systemic JRA) and 17 controls matched for age and sex. Nutritional status was assessed for height, weight, and fat-free mass (FFM), and REE was measured with indirect calorimetry. RESULTS: Nutritional status in the patients with systemic JRA was diminished compared to the controls for height (140 vs. 159 cm; p<0.01) and FFM (28 vs. 38 kg; p = 0.03). Oligo and polyarticular patients with JRA had normal height and FFM. No significant differences existed in crude REE among the groups. However, after correcting REE for body weight and FFM, the patients with systemic JRA, compared to controls, had 18% higher REE per kg body weight (159 vs. 134 kJ/kg/day; p<0.01) and 21% higher REE per kg FFM (196 vs. 162 kJ/kg/day; p<0.01). Oligo and polyarticular JRA patients had 8% increased values for REE per kg body weight or FFM, but these differences were not statistically significant. CONCLUSION: Patients with systemic JRA show stunting, low FFM, and a significantly increased REE when nutritional status is taken into account. These data suggest that assessment of individual energy requirements should include correction for fat-free mass in the treatment of malnutrition in patients with systemic JRA.     

Resting energy expenditure, cardiovascular risk factors and insulin resistance in obese patients

OBJECTIVE: The aim of our study was to determine whether energy expenditure modified by increasing body mass over the wide range of body mass index (BMI) was related to insulin resistance, cardiovascular risk factors and dietary intakes. SUBJECTS AND METHODS: A population of 87 obese non-diabetic outpatients was analyzed prospectively. Indirect calorimetry, tetrapolar electrical bioimpedance, serial assessment of nutritional intake using written 3-day food records and biochemical analyses were performed. RESULTS: The mean age was 45.1 +/- 16.7 years and the mean BMI was 35.2 +/- 5.2. Indirect calorimetry showed a resting metabolic rate (RMR) of 1,732.2 +/- 406.6 kcal/day and oxygen consumption of 266.2 +/- 63.3 ml/min. RMR corrected by fat-free mass was 36.8 +/- 14.1 kcal/day/kg. Serial assessment of nutritional intake using written 3-day food records showed a calorie intake of 1,660 +/- 551.7 cal/day, a carbohydrate intake of 168.63 +/- 76.6 g/day, a fat intake of 72.1 +/- 26.42 g/day and a protein intake of 81.1 +/- 23.3 g/day. Insulin, HOMA, systolic blood pressure, diastolic blood pressure, waist circumference, fat mass, waist-to-hip ratio were higher in the third BMI tertile than in the first and second tertiles. No differences were detected in calorie intake, carbohydrate intake, fat intake, protein intake, drinking and alcoholic habit among BMI tertiles. RMR was similar in the different tertiles and the corrected RMR by fat-free mass was higher in first tertile than in the second and third tertiles (44.2 +/- 20.7 vs. 34.5 +/- 9.1 vs. 33.1 +/- 8.5 kcal/kg/day; p < 0.05). In multivariate analysis with a dependent variable (RMR), the fat-free mass remained in the model (F = 7.8; p < 0.05), with an increase of 10.1 (95% CI 3.6-17.5) kcal/day with each 1 kg of fat-free mass adjusted by age and sex. CONCLUSION: Resting energy expenditure in obese patients is not related to the BMI, insulin resistance and dietary intake. RMR is related to fat-free mass in a multivariant model.     

Resting energy expenditure and body composition in morbidly obese,obese and control subjects

Resting energy expenditure (REE) was investigated by indirect calorimetry in relation to body composition and to different degrees of obesity in order to assess if a defective energy expenditure contributes to extra body fat accumulation. Differences were found between control subjects (group C; BMI 23±0.5 kg/m², REE 5890±218 kJ/day; mean±SEM) and obese subjects (group O; BMI 34.2±0.9 kg/m², REE 7447±360 kJ/day;P<0.0001) and between group C and morbidly obese subjects (group MO; BMI 49.9±1.6 kg/m², REE 8330±360 kJ/day;P<0.0001); REE was not significantly different between groups O and MO. Body composition data were obtained by means of body impedance analysis. Even though group MO had a fat mass higher than group O, body cell mass, the metabolically active body compartment, was similar in groups O and MO, and this fact may have contributed to the similar REE in the two groups. Multiple regression analysis gave the following equation as the best predictor of REE: REE (kJ/day)+1591±49_BW+74_BCM–737 _G (R ²=0.88), where BW is body weight, BCM is body cell mass andG is a dummy variable coding group membership (group C=1; group O=2; group MO=3). Thus the analysis showed a negative impact of obesity on REE beyond body composition variables.     

Resting energy expenditure in type 2 diabetic patients and the effect of insulin bolus

AimsResting energy expenditure (REE) plays a critical role in the regulation of body weight, with important implications in type 2 diabetes (T2D). However, the relationships between REE and T2D have not been extensively evaluated. We compared REE in persons with diabetes and in persons without diabetes. We also investigated the acute effect of insulin on REE and venous lactate, the latter an indirect measure of neoglucogenetic activity.MethodsREE was measured using indirect calorimetry in 14 newly diagnosed, untreated T2D adults and in 14 non-diabetic age-, gender- and body mass index-matched persons. The REE and lactate venous concentrations were also measured in a subgroup of 5 T2D patients in the hour following an IV insulin bolus.ResultsThe REE normalized for fat-free mass (FFM) was significantly higher in T2D patients than in the group without diabetes (mean ± SD: 27.6 ± 1.9 vs. 25.8 ± 1.9 kcal/kg-FFM·24 h; P = 0.02). REE normalized for FFM was correlated with fasting plasma glucose concentration (r = 0.51; P = 0.005). Following the insulin venous bolus REE (0′: 2048 ± 242; 10′: 1804 ± 228; 20′: 1684 ± 230; 30′: 1634 ± 212; 45′: 1594 ± 179; 60′: 1625 ± 197 kcal/24 h; P < 0.001) and both glucose (P < 0.001) and lactate (P < 0.001) concentrations progressively declined in the ensuing hour.ConclusionsPatients with diabetes have a higher energy expenditure, likely a consequence of higher gluconeogenetic activity. This study may contribute to recognizing the nature of body weight reduction that occurs in concomitance with poorly controlled diabetes, and of body weight gain as commonly observed when hypoglycemic treatment is started.     

老年慢性阻塞性肺疾病患者静息能量消耗与人体组成

目的探讨老年慢性阻塞性肺疾病（COPD）患者与老年正常对照组静息能量消耗（REE）与非脂体质（fat free mass,FFM）、瘦体质（lean mass,LM）的关系,为老年COPD患者营养支持治疗提供依据。方法用间接能量测定法测定43例老年COPD患者（男性25例,女性18例）和40例老年对照者（男性22例,女性18例）的REE,根据Harris-Benedict公式计算REE占预计值的百分比;同时运用双能X线吸收法测定人体组成,即FFM、LM值以及脂肪的比例。结果老年COPD患者FFM占体重比重（FFM%）、LM%均低于对照组,脂体质（FM）%则高于对照组,差异均有统计学意义;COPD组REE%也高于对照组,差异有统计学意义,COPD组基础代谢率（BMR）、REE与FFM和LM的比值（REE/FFM、REE/LM）都高于对照组;Pearson＇s相关性分析显示病例组和对照组REE与体重指数（BMI）、体表面积（BSA）、FFM和LM均呈中重度相关,差异都有统计学意义。结论老年COPD患者REE升高,FFM或LM的比例下降,提示COPD患者常常出现骨骼肌的萎缩。老年COPD患者和对照组REE和FFM和LM也有良好的正相关性。因此,如果样本量足够大,建立REE关于FFM或者LM的回归方程,对于指导临床营养支持治疗可能有一定的实际价值。     

Resting energy expenditure in OSAS: the impact of a single CPAP application

Purpose

Data on the impact of obstructive sleep apnea syndrome (OSAS) and its treatment on resting energy expenditure (REE) are currently few and conflicting. The purpose of the present study was to investigate the impact of OSAS on REE, as measured before and after sleep, and the changes in REE after a single continuous positive airway pressure (CPAP) application, for the first time in literature.

Methods

This is a nested case-control study. From the initial study population, two groups were formed, based on the results of nocturnal polysomnography: a group of male OSAS patients and a group of male, age-matched non-OSAS controls. REE was measured in both groups before and after sleep by indirect calorimetry, while patients repeated REE measurements before and after a single nasal CPAP application.

Results

Ninety-two male OSAS patients (45.3?±?12.8 years old) and 19 male non-OSAS controls (50.8?±?11.7 years old) were studied. REE/lean body mass (LBM) was higher among patients compared to controls both pre- (29.6?±?12 vs 22.9?±?7.9 kcal/kg; p?=?0.022, correspondingly) and post-sleep (26.4?±?9.6 vs 21.6?±?9 kcal/kg; p?=?0.047 correspondingly). REE/LBM decreased significantly after sleep in OSAS patients (p?=?0.002), but not in controls; this difference was most evident among patients with more severe disease and higher desaturation. A single nasal CPAP application diminished the pre-post REE/LBM difference (30.3?±?8.2 vs 28.3?±?10.3 kcal/kg; p?=?0.265), but only among responders.

Conclusions

In OSAS patients, REE values are high and vary significantly before and after sleep. A single nasal CPAP application diminishes this difference among responders, possibly through reversal of nocturnal desaturation.