Energy Expenditure in the ICU

Can measured resting energy expenditure be estimated by formulae in daily clinical nutrition practice?

PURPOSE OF REVIEW

To recognize the fundamental factors that alter energy expenditure on a daily basis and the impact they have on the measurement of caloric consumption by the human body, through respiratory indirect calorimetry, and thus to try to determine which predictive equation best correlates with total energy expenditure generated from energy measurements.

RECENT FINDINGS

The most important compartment of the body, for its metabolic activity and influence upon resting metabolic rate, is fat-free mass. Other variables affecting energy expenditure are sex, weight, height, age, body surface area, fat mass and ethnicity. Metabolic and activity factors such as the thermic effect of nutrients, facultative thermogenesis, anabolism/growth and physical activity, also contribute, comprising total daily energy expenditure. Following the pioneering work of Harris and Benedict for the estimation of energy expenditure, several authors turned their experimental interest to this area, and various recent predictive formulae were derived. These are useful and easy to apply in daily clinical nutrition practice. However, because of the cited variables upon energy expenditure, the final daily caloric estimates show inherent errors ranging from -23.5 to +22.5% upon measured caloric expenditure. These are particularly remarkable in critically ill patients who are exposed to medical and surgical interventions.

SUMMARY

One has to be careful in choosing, understanding and clinically applying the results from predictive equations, bearing in mind that the original population from which the equation was derived does not always correspond to that currently being evaluated.