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augustus 22, 2014 om 2:36 pm #720Robert DaviesGast
I am currently in my 2nd year of a dietetics degree at Plymouth university in the UK. I am currently interested in the use and efficacy of stress factors, sometimes referred to as injury factors, in acute disease and BMR calculation to account for metabolic stress. I am writing to ask whether you would be able to tell me if you use such factors in clinical practice in the Netherlands and if at all possible detail what these factors are. This forum was suggested to me by the Dutch representative of the International Confederation of Dietetic Associations and I hope you do not mind me contacting you.
In the UK, there is a growing trend in using the Henry (2005) calculation to determine BMR but Schofield is still in use with some dietitians. The BMR is then combined with an activity factor and a relevant stress factor. The stress factors for clinical conditions used are recommended by the Parenteral and Enteral Nutrition Group of the British Dietetic Association and are as follows:
Brain injury: acute (ventilated and sedated) 0-30%
Haemorrhagic stroke: 30%
Ischaemic stroke: 5%
Chronic obstructive pulmonary disease: 15-20%
Inflammatory bowel disease: 0-10%
Intensive care: ventilated 0-10%
Pancreatitis: chronic 3%
Solid tumours: 0-20%
Surgery: uncomplicated 5-20%
I would be extremely thankful for your input or if you feel there is someone more able to provide this information please feel free to forward my e-mail to them.
If you have any questions please do not hesitate to contact me.
Robert Davies augustus 23, 2014 om 5:54 pm #724Hinke KruizengaGast
Thank you for this interesting question.
We recently tested 35 predictive equations in a group of 227 inpatients and 188 outpatients. In total group, Korth (2007) and FAO/WHO/UNU (1985) with weight and height and Marra (2003) were most accurate but, even in these best performing equations, only 50% of the patients the REE was calculated accurately (within +/-10% of calorimetry measurement). In BMI subgroups, FAO/WHO/UNU (1985) predicted REE accurately in 44% of underweight, 52% of normal weight and 61% of overweight patients. In obese patients, Mifflin (1990) with weight and Weijs (2008) predicted 57% accurately. Age, BMI, FFM, FM and CRP appeared to be predictive determinants in calculating REE. Building a new equation with these determinants did not improve the percentage of accurately caluculated REE.
Our conclusion is that existing predictive equations do not predict REE accurately. When indirect calorimetry is not available, FAO/WHO/UNU (1985) with weight and height is best usable in underweight, normal weight and overweight patients. In obese patients, Mifflin (1990) with weight and Weijs (2008) are best usable. Age, BMI, FFM, FM and CRP are predictive determinants but do not improve predicted REE.
These results will be presented for publication to a scientific journal soon.
Your question on additional factors to calculate TEE is topic of discussion. Since activity will be reduced during illness we use either an additional factor for activity OR for disease. In most patients an additional factor of 30% will be enough. In specific patient groups more scientific information on additional factors is available. Still, we keep the maximum of 50% to prevent accumulation of additional factors.
Dr. Peter Weijs is the expert in this field of our group. He promised to comment on this topic later next week at this forum.