Energy requirements of non-ambulatory, tube-fed adult patients with cerebral palsy and chronic hypothermia

OBJECTIVES

We investigated the energy requirements of non-ambulatory patients with severe neurodevelopmental disabilities and chronic hypothermia.

METHODS

Six adult patients with a permanent ostomy for tube feeding were studied. Otic temperature was taken before the indirect calorimetry measurements. Prescribed tube-feeding intake and nutrient prescription changes were evaluated for 4 y for each patient. Monthly body weights and periodic anthropometric body fat assessments were measured for assessment of the need for weight gain, loss, or maintenance. The prescribed caloric intake was compared with the measured energy expenditure when normothermic, the Harris-Benedict equations, and the Arlington Developmental Center equation for non-ambulatory adult patients with severe neurodevelopmental disabilities (estimated resting energy expenditure [kcal/d] = [22.3 x fat-free mass [kg]] - [9.4 x age [y]] + 557).

RESULTS

Mean energy expenditure was 783 +/- 81 kcal/d or 29.0 +/- 10.9 kcal. kg(-1)d(-1) when normothermic versus 606 +/- 11 kcal/d or 19.5 +/- 8.5 kcal. kg(-1)d(-1) (P < 0.05) when hypothermic (36.9 degrees C +/- 0.4 versus 35.5 degrees C +/- 0.4; P < 0.02), respectively. Prescribed caloric intakes to achieve weight gain, maintenance and loss were 138 +/- 13%, 105 +/- 15%, and 74 +/- 11% of the measured energy expenditure when normothermic (P < 0.001); 107 +/- 19%, 86 +/- 18%, and 56 +/- 3% of the Harris-Benedict equations (P < 0.02); or 130 +/- 23%, 100 +/- 19%, and 75 +/- 11% of the Arlington Developmental Center equation (P < 0.02).

CONCLUSIONS

Measured energy expenditure when the patient is normothermic significantly overestimated actual caloric needs. The energy intake necessary to achieve desired weight changes are restrictive when compared with the basal energy expenditure, Arlington Developmental Center equation, or measured energy expenditure when normothermic.

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Measured energy expenditure of tube-fed patients with severe neurodevelopmental disabilities

OBJECTIVE

To determine measured resting energy expenditure (REE) of nonambulatory tube-fed patients with severe neurological neurodevelopmental disabilities.

METHODS

Twenty patients were prospectively studied. Only steady state indirect calorimetry measurements were taken. All measurements were conducted using a canopy system. Nutritional needs were met entirely by enteral feedings via a permanent ostomy.

RESULTS

REE was widely distributed from 16 kcals/kg/day to 39 kcals/kg/day. The mean REE (888+/-176 kcals/day) of the patients was significantly (p<0.01) lower than predicted as estimated by the Harris-Benedict equations (1081+/-155 kcals/day) and World Health Organization equations (1194+/-167 kcals/day). Fat-free mass (FFM) was the best parameter for predicting REE. Two predictive equations were developed that are not significantly biased and more precise (< or =15% error) than conventional predictive formulas.

CONCLUSION

Conventional formulas for estimating energy expenditure are inaccurate and generally overestimate measured energy expenditure of nonambulatory patients with severe developmental disabilities.