New prediction equations for resting energy expenditure in older hospitalized patients: Development and validation

Fumiya Kawase; Yoshiyuki Masaki; Hiroko Ozawa; Manami Imanaka; Aoi Sugiyama; Hironari Wada; Shinya Kobayashi; Takayoshi Tsukahara

doi:10.1016/j.nut.2023.112188

New prediction equations for resting energy expenditure in older hospitalized patients: Development and validation

Nutrition. 2023 Nov:115:112188. doi: 10.1016/j.nut.2023.112188. Epub 2023 Aug 6.

Authors

Fumiya Kawase¹, Yoshiyuki Masaki², Hiroko Ozawa³, Manami Imanaka³, Aoi Sugiyama³, Hironari Wada⁴, Shinya Kobayashi⁵, Takayoshi Tsukahara⁶

Affiliations

¹ Department of Nutrition, Asuke Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan; Graduate School of Nutritional Science, Nagoya University of Arts and Sciences, Aichi, Japan. Electronic address: fumi.kawase@gmail.com.
² Department of Internal Medicine, Asuke Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan; Department of Community-based Medical Education, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan.
³ Department of Nursing, Asuke Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan.
⁴ Department of Rehabilitation Therapy, Asuke Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan.
⁵ Department of Internal Medicine, Asuke Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan.
⁶ Graduate School of Nutritional Science, Nagoya University of Arts and Sciences, Aichi, Japan.

PMID: 37729675
DOI: 10.1016/j.nut.2023.112188

Abstract

Objectives: Accurate resting energy expenditure (REE) prediction is needed to prevent over- or underfeeding in older hospitalized patients. However, few validated REE prediction Equations are known for such patients. Therefore, this study aimed to develop new REE prediction Equations and evaluate their validity.

Methods: This single-center, cross-sectional study enrolled 134 patients ages ≥70 y. For holdout validation, patients were randomized in a 3:1 ratio; for the development data set, a new Equation was developed according to the measured REE using indirect calorimetry. The new and existing Equations were compared using the validation data set.

Results: Mean patient age was 87.4 ± 6.9 y, and 34.3% were male. Two Equations were developed in multivariable regression models: Equation 1: REE (kcal/day) = 313.582 + Height (cm) × 3.973 + Body weight (kg) × 5.332 - Age (y) × 5.474 - (0 if male; 1 if female) × 20.012 + Calf circumference (cm) × 12.174; and Equation 2: REE (kcal/day) = 594.819 + Height (cm) × 3.760 + Body weight (kg) × 8.888 - Age (y) × 6.298 - (0 if male; 1 if female) × 16.396. The mean relative bias (95% CI) with measured REE as a reference had a small bias for Equations 1 and 2 (-0.1 [-4.1 to 3.9]% and -0.2 [-4.4 to 4.1]%, respectively); however, the Harris-Benedict, Food and Agriculture Organization of the United Nations/World Health Organization/United Nations University, Ganpule, and body weight × 20 Equations had larger biases (-6.2 [-10.3 to -2.0]%; 5.3 [1.3 to 9.3]%; -13.9 [-18.6 to -9.3]%; and -11.6 [-16.1 to -7.1]%, respectively).

Conclusions: New prediction Equations using height, body weight, age, sex, and calf circumference improve REE prediction accuracy in older hospitalized patients.

Keywords: Hospitalized patients; Indirect calorimetry; Older patients; Prediction accuracy; Resting energy expenditure.