正常人及慢性阻塞性肺病患者的静息能量消耗测定意义

正常人及慢性阻塞性肺病患者的静息能量消耗测定意义聂秀红林英翔董声焕翁心植我们应用开放式间接代谢测定仪测定健康成人及慢性阻塞性肺病（ＣＯＰＤ）患者的静息能量消耗（ＲＥＥ），进一步评价ＨａｒｒｉｓＢｅｎｅｄｉｃｔ公式（ＨＢＥ）估算能量消耗的临床应用价值，...     

肝衰竭的营养代谢异常与营养支持治疗的研究进展

营养和代谢损害是严重肝病的重要表现,并已成为影响患者预后的明确危险因素.本文对肝衰竭患者的营养代谢异常与营养支持治疗作一综述,总结了肝脏疾病营养代谢状况评价的指标,以及肝衰竭患者营养物质及能量代谢特点,指出利用CCM-D营养代谢测试系统可以测定肝衰竭患者的静息能量消耗,慢性肝衰竭患者能量供给以脂肪氧化为主、呼吸商明显低于预测值,并进一步讨论了不同阶段肝衰竭营养支持干预的方式及摄入量等.目的在于提高临床医师对肝衰竭患者营养代谢异常的认知程度,制定个体化的营养支持治疗,从而为提高肝衰竭的抢救成功率、改善患者的中远期预后提供条件.     

老年慢性阻塞性肺疾病患者静息能量消耗与人体组成的改变

通过测定老年慢性阻塞性肺疾病（COPD）患者和老年对照者的静息能量消耗（REE）和人体组成并比较其差异，为老年COPD患者营养支持治疗提供依据。     

慢性阻塞性肺疾病患者静息能量消耗测定及意义

为探讨慢性阻塞性肺疾病患者发生营养不良后能量代谢的特点及意义，测定了２８例营养不良和２４例营养状态正常的缓解期ＣＯＰＤ患者的静息能量消耗和糖、脂肪及蛋白质氧化产生能量占ＲＥＥ的比例，并与２０例健康人进行比较。结果显示，营养不良ＣＯＰＤ患者的ＲＥＥ与预计值比值明显高于营养正常的ＣＯＰＤ患者和对照组，脂肪氧化产生能量占ＲＥＥ的比例高于后两者，蛋白质氧化产生能量所占比例低于两者。提示营养不良ＣＯＰＤ患者     

精氨酸对慢性阻塞性肺疾病合并营养不良的免疫调理作用

目的　研究精氨酸对慢性阻塞性肺疾病 (COPD)合并营养不良患者的免疫调理作用。方法　对 30例营养不良的COPD病人进行总能量摄入均为静息能量消耗 (REE) 1 5倍的营养支持。A组 (12例 )为精氨酸治疗组 ,每日口服L 精氨酸 30 g ,B组 (18例 )为对照组。 结果　A组TSF、PAlb、CHI等营养参数明显较B组改善 ,A组TNF α、CD8治疗后显著下降 ,而IL 2、NO、IgG、CD4 等显著上升 (P <0 0 5 )。结论　精氨酸对COPD合并营养不良患者不仅具有辅助营养支持作用 ,而且还有免疫调理作用。     

L-精氨酸对慢性阻塞性肺病营养支持增效作用的探讨

目的:评价L-精氨酸对慢性阻塞性肺病(COPD)营养支持的增效作用。方法:对30例COPD患者进行营养支持治疗，总能量摄入为静息能量消耗(REE)的1．5倍，其中蛋白质占20％，脂肪30％，碳水化合物50％。12例为精氨酸治疗组，口服L-精氨酸10g，每天3次，18例为对照组，观察效果。结果:营养支持后，精氨酸组肱三头肌皮褶厚度、前白蛋白、体脂等营养参数较对照组明显改善，呼吸肌力显著提高，REE显著下降。结论:L-精氨酸不仅改善COPD的营养状况和呼吸肌力量，而且能显著降低患者的能量消耗，强化营养支持的效果，改善预后。     

重症急性胰腺炎肠内营养研究进展

重症急性胰腺炎(severe acute pancreatitis,SAP)是一种全身性的炎症反应,常伴有多器官衰竭,病死率高达20%～30%.患者处于一种高代谢、高分解的状态,能量消耗大,静息能量消耗约为基础能量消耗的139%～149%.因此,一个合理的营养支持模式是必要的.     

克隆病患者的代谢效率降低

本文旨在通过随访10例用类固醇治疗及持续肠道营养的克隆病患者的能量、底物、氮平衡及人体组份变化,以探索发病期间能量储蓄和体重增加对进食过量的反应。 10例经活检证实的克隆病患者刚获临床缓解。在行24h持续标准配方流质鼻饲前先查基础代谢率和人体组份分析。5例为第一组(8天内稳定持续灌注率是基础能量消耗的1.5倍),另5例为第二组(第2、4、6、8天的能量灌注率分别是静息代谢率的0.5、1、1.5、2     

不同方法测定重症急性胰腺炎患者能量消耗值的一致性和相关性研究

目的分析间接测热法(IC)与哈里斯-本尼迪克特估算法(H-B)测定重症急性胰腺炎(SAP)患者能量消耗的一致性和相关性, 以及不同病因SAP患者的静息能量代谢特点, 以指导临床目标能量营养支持方案的制订。方法纳入2019年2月1日至12月31日入住南昌大学第一附属医院重症监护室的61例SAP患者, 收集患者的相关资料如SAP病因, 是否需要机械通气, 以及代谢状态等。所有患者入住重症监护室后第1天接受IC测定, 根据IC测定的能量消耗值(以下简称IC值)与H-B测定的能量消耗值(以下简称H-B值)确定SAP患者处于高、正常或低代谢状态。采用Bland-Altman法和Pearson线性回归分析2种方法测定能量消耗值的一致性、相关性, 并拟合线性方程。统计学方法采用配对t检验。结果 61例SAP患者中, 13例为胆源性SAP, 30例为高脂血症性SAP, 6例为酒精性SAP, 12例为其他原因或未明原因SAP;19例需机械通气, 42例无需机械通气;70.5%(43/61)的SAP患者处于高代谢状态, 13.1%(8/61)的患者处于正常代谢状态, 16.4%(10/61)的患者处于低代...     

结核病营养治疗专家共识

营养治疗是结核病治疗的基础,是结核病自然病程中必不可少的预防和控制措施。结核病患者病情复杂多变,在机体代谢和能量消耗等方面有其特点,合理的营养供给不仅是一种支持手段,也是影响疾病进程和预后的重要治疗措施。为推动中国结核病营养治疗的普及和规范,更好地发挥营养在结核病治疗中的作用,促进相关科研工作开展,中华医学会结核病学分会重症专业委员会组织国内结核病和营养学专家,根据我国目前结核病营养治疗的经验和方法,同时结合美国、欧洲及我国最新的肠内肠外营养指南,制定了"结核病营养治疗专家共识",使结核病患者得到规范、持久的营养治疗,提高结核病患者生存质量,降低并发症,最终提高结核病患者的整体水平。     

Impact of estrogens on resting energy expenditure: A systematic review

The fear of weight gain is one of the main reasons for women not to initiate or to early discontinue hormonal contraception or menopausal hormone therapy. Resting energy expenditure is by far the largest component and the most important determinant of total energy expenditure. Given that low resting energy expenditure is a confirmed predictive factor for weight gain and consecutively for the development of obesity, research into the influence of sex steroids on resting energy expenditure is a particularly exciting area. The objective of this systematic review was to evaluate the effects of medication with natural and synthetic estrogens on resting energy expenditure in healthy normal weight and overweight women. Through complex systematic literature searches, a total of 10 studies were identified that investigated the effects of medication with estrogens on resting energy expenditure. Our results demonstrate that estrogen administration increases resting energy expenditure by up to +208 kcal per day in the context of contraception and by up to +222 kcal per day in the context of menopausal hormone therapy, suggesting a preventive effect of circulating estrogen levels and estrogen administration on weight gain and obesity development.     

Ascites increases the resting energy expenditure in liver cirrhosis

The purpose of this study was to investigate the effect of ascites on the energy metabolism of patients with liver cirrhosis. The resting energy expenditure was determined in 10 patients with liver cirrhosis and ascites of moderate or large volume. The resting energy expenditure measurement was performed using indirect calorimetry and the resting energy expenditure predictive value was calculated with the Harris-Benedict equation, both before and after removal of ascitic fluid by paracentesis. Metabolic stress factors were absent in all cases. After an interval of 11.2 +/- 7.7 days between measurements, a weight loss of 16.6 +/- 10.3 kg was observed with paracentesis. The resting energy expenditure measured by indirect calorimetry showed a statistically significant decrease from 1682 +/- 291 to 1523 +/- 240 kcal/day (P less than 0.005) after removal of ascites. The repeatability of our indirect calorimetry method only allowed for the analysis of the results in 4 of 10 patients in whom ascites removal produced a consistent decrease in resting energy expenditure. There were no statistically significant differences between the measurements obtained by indirect calorimetry and those provided by the Harris-Benedict equation, but the latter had a moderate reliability in predicting the real resting energy expenditure of every patient. Our results suggest that, far from being an inert volume, ascites may be associated, at least in some patients, with an increased resting energy expenditure and therefore accelerate the appearance of protein energy malnutrition with corresponding complications.     

Chronic sympathetic attenuation and energy metabolism in autonomic failure

The sympathetic nervous system regulates thermogenesis and energy homeostasis in humans. When activated it increases energy expenditure, particularly resting energy expenditure. Most human studies used acute infusion of β-blockers as a model to eliminate sympathetic stimulation and to examine the contribution of the sympathetic nervous system to energy metabolism and balance. Clinically, however, it is also important to assess the effect of chronic sympathetic attenuation on energy metabolism. In this context, we hypothesized that resting energy expenditure is decreased in patients with autonomic failure who, by definition, have low sympathetic tone. We measured 24-hour energy expenditure using whole-room indirect calorimeter in 10 adults with chronic autonomic failure (6 women; age, 64.9±9.1 years; body mass index, 25.2±4.4 kg/m(2)) and 15 sedentary healthy controls of similar age and body composition (8 women; age, 63.1±4.0 years; body mass index, 24.4±3.9 kg/m(2)). In 4 patients, we eliminated residual sympathetic activity with the ganglionic blocker trimethaphan. We found that, after adjusting for body composition, resting energy expenditure did not differ between patients with autonomic failure and healthy controls. However, resting energy expenditure significantly decreased when residual sympathetic activity was eliminated. Our findings suggest that sympathetic tonic support of resting energy expenditure is preserved, at least in part, in pathophysiological models of chronic sympathetic attenuation.     

Hormonal and physiological correlates of energy expenditure and substrate oxidation in middle-aged, premenopausal women.

An understanding of the hormonal and physiological correlates of energy expenditure and substrate oxidation in middle-aged women will increase our knowledge of factors that promote changes in energy balance and adiposity. We measured resting and postprandial energy expenditure and substrate oxidation in 59 middle-aged, premenopausal women (mean+/-sD age, 47+/-2 yr) to examine the hormonal and physiological correlates of energy and substrate metabolism. Energy expenditure and substrate oxidation were measured at rest using indirect calorimetry and urinary nitrogen excretion and for 180 min after the ingestion of a liquid meal (10 kcal/kg fat-free mass; 410+/-44 Cal). Fasting hormone levels were measured by RIA, glucose tolerance was determined by a 75-g oral glucose tolerance test, body composition was measured by dual energy x-ray absorptiometry, and peak aerobic capacity was determined by a treadmill test. Using stepwise regression analysis, we found that resting energy expenditure was predicted by fat-free mass and serum leptin concentration (r2 = 66%; P < 0.01), fat oxidation was predicted by resting energy expenditure (r2 = 17%; P < 0.01), and carbohydrate oxidation was predicted by serum leptin and appendicular skeletal muscle mass (r2 = 21%;P < 0.01). Novariables were related to postprandial energy expenditure or substrate oxidation. We conclude that in middle-aged, premenopausal women, variation in resting energy expenditure and substrate oxidation is primarily explained by fat-free mass and serum leptin levels. Thus, changes in metabolically active tissue mass or leptin concentration may partially contribute to changes in resting energy expenditure or substrate oxidation in middle-aged women.     

Assessment of resting energy expenditure and body composition in Japanese pregnant women with diabetes

Aims/Introduction

To measure longitudinal changes in resting energy expenditure and body composition of Japanese pregnant women with or without diabetes.

Materials and Methods

The study population consisted of women who had delivered a live singleton neonate after 22 weeks’ gestation at Okayama University Hospital from July 2013 to June 2017. Resting energy expenditure and body composition were measured in the first trimester, second trimester, third trimester and postpartum.

Results

A total of 144 women participated in this study: 103 with normal glucose tolerance and 41 with diabetes. The resting energy expenditure (kcal/day) of pregnant women with normal glucose tolerance was significantly higher in the third trimester (1,644 ± 234) than in the first (1,461 ± 215) and second trimesters (1,491 ± 219), and postpartum (1,419 ± 254), whereas that of pregnant women with diabetes did not significantly change during all periods (1,568 ± 404, 1,710 ± 332, 1,716 ± 251, 1,567 ± 249). The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Fat‐free mass was closely correlated with resting energy expenditure.

Conclusions

The resting energy expenditure of Japanese pregnant women with normal glucose tolerance was significantly increased in the third trimester. The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Resting energy expenditure and fat‐free mass are potential indexes for medical nutrition therapy in pregnant women with diabetes.     

24-hour energy metabolism in the human: circadian rhythm, relation to body weight and nutrition

In 7 men with normal weight and 9 man with overweight and healthy metabolism the resting and fasting energy expenditure was indirectly calorimetrically pursued in the open system over 24 hours. The total energy expenditure over 24 hours revealed an ascertained dependence on body-weight and nutrition. The persons with overweight had a higher absolute energy expenditure, however, the activity of the energy metabolism of the body mass free from fat and the active body mass, respectively, decreased with increasing overweight. The resting and fasting energy expenditure showed in all measured parameters (oxygen consumption, respiratory quotient and nitrogen excretion in the urine) an ascertained daily periodicity (circadian rhythm), which was widely independent of body weight. Only the average daily level C0 (rhythm adjusted level) of the resting and fasting energy expenditure was positively correlated with the body weight and the food energy intake. A negative energy balance (reduction 1.2 MJ/d over 28 days) influenced only the total energy and substrate balance over 24 hours and the daily average level, respectively. The circadian conditions remained unchanged (Chossat's phenomenon). The variability in daily rhythm of the energy expenditure of nearly 25% of the daily average should be taken into consideration in the judgment of exogenically stimulated changes in the energy metabolism.     

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.     

Relation of serum leptin levels and regulation of resting energy expenditure

Leptin is a protein hormone produced by adipocytes. Its serum concentrations in the most of cases positively correlate with total body fat content and body mass index (BMI). Leptin plays a role in the food intake regulation. It also increases resting energy expenditure in hypoleptinaemic ob/ob mice. Its relationship to resting energy expenditure in human is less clear. The aim of our study was to follow the serum leptin levels in healthy females (n = 12) and males (n = 14) and their relationship to resting energy expenditure, body fat content, other antropometric and nutritional biochemical parameters. It was found that serum leptin levels were significantly higher in females comparing to males (6.8 +/- 3 ng.ml-1 vs. 2.6 +/- 1 ng.ml-1, p < 0.05). The serum leptin levels correlated positively with body fat content and body mass index in both groups. In females the positive correlation between body weight and serum leptin levels was found. No statistically significant relationship between serum leptin levels and resting energy expenditure, serum total protein, albumin or prealbumin concentration was found in any of studied groups. The results of our study do not testify to direct relationship between serum leptin levels and resting energy expenditure in young healthy individuals.     

Increased energy expenditure in growing adolescents with Crohn's disease

Undernutrition is considered to have a central role in the pathogenesis of growth retardation in Crohn's disease. This may occur as a consequence of inadequate food intake, increased energy expenditure, or both. Ten growing adolescents with inactive Crohn's disease were assessed with respect to anthropometric parameters and resting energy expenditure, measured by indirect calorimetry during remission, repeated in relapse (N=5), and compared to that predicted from the Harris-Benedict formula. Mean energy intake was assessed with seven-day diaries in five patients and compared to recommended intake for age, sex, weight, and physical activity. Ten healthy, growing, age- and sex-matched adolescents served as controls. Nine patients with inactive Crohn's disease, who had ceased growing, were matched for disease site and duration and acted as disease controls. Patients and disease controls had lower body mass index (19.2±0.6; 20.9±0.7) than healthy controls (23.7±0.6;P<0.001). Percent body fat was lower in patients (13.2±1.9%) compared to healthy controls (20.5±2.4%;P<0.05) but not to disease controls (17.0±2.6%). Patients had higher resting energy expenditure per kilogram of fat-free mass than disease or healthy controls (36.9±5.1; 32.9±2.6; 30.9±2.1 kcal;P<0.02). Measured resting energy expenditure in patients, but not in disease or healthy controls, was higher than the predicted (measured: predicted 1.15, 1.03, 0.9, respectively;P<0.03). Energy intake in patients was 97% of recommended intake but the measured ratio of energy intake/resting energy expenditure was lower than the predicted ratio (1.49 vs 1.71;P<0.05). During subsequent relapse in five patients resting energy expenditure was unchanged. In growing adolescents with inactive Crohn's disease, there is increased energy expenditure that is not accompanied by an increase in energy intake. Relapse of disease does not appear to increase resting energy expenditure further but may divert energy from growth to disease activity. This suggests that nutritional therapy should be directed towards increasing caloric intake to maximize growth potential.     

Nutritional assessment in patients with cirrhosis: the use of indirect calorimetry

BACKGROUND: Malnutrition is frequent in cirrhotic patients, and its assessment is difficult. Functional assessment through a dynamometer is a simple method and could minimize these drawbacks. Harris-Benedict prediction formulae estimates the resting energy expenditure but has not been validated for this population. One alternative is the use of indirect calorimetry. AIM: To assess nutritional status in cirrhotic patients and estimates the resting energy expenditure through indirect calorimetry and compares it to Harris-Benedict. PATIENTS AND METHODS: Thirty four adult hepatitis C cirrhotic outpatients were studied, classified by Child-Pugh and model of end-stage liver disease score. The resting energy expenditure was predicted through Harris-Benedict and measured by indirect calorimetry. Nutritional assessment was done through anthropometry, subjective global assessment, hand-grip strength and a 3-day recall. RESULTS: Fifteen (44.2%) were Child-Pug A, 12 (35.3%) B and 7 (20.6%) C, and 33 (97.1%) had model of end-stage liver disease scores less than 20. The resting energy expenditure predicted was higher than the measured (Harris-Benedict 1404.5 +/- 150.3 kcal; indirect calorimetry 1059.9 +/- 309.6 kcal). The prevalence of malnutrition varied between methods (body mass index, muscle arm circumference, subjective global assessment, triceps skinfold thickness and hand-grip strength: 0; 5.9; 17.6; 35.3 and 79.4%, accordingly). Calories and proteins intake were 80% and 85% of recommended amounts and there was inadequate intake of calcium, magnesium, iron and zinc. CONCLUSION: Malnutrition was frequent and hand-grip strength seemed to be the most sensitive method for its diagnosis. Calories and protein intakes were inadequate. Considering that the predicted resting energy expenditure was higher than the measured one and the need to offer higher caloric intake, the use of the predicting equation may replace indirect calorimetry.