Research output: Contribution to journal › Article › peer-review
Predicted estimates of resting energy expenditure have limited clinical utility in patients with cirrhosis: an individual patient data analysis. / Limon-Miro, Ana Teresa; Jackson, Clive Douglas; Eslamparast, Tannaz ; Yamanaka-Okumura, Hisami ; Plank, Lindsay Dudley ; Henry, Christiani Jeyakumar; Madden, Angela; Ferreira, Livia Garcia ; Kalaitzakis, Evangelos ; Prieto de Frías, César ; Knudsen, Anne Wilkens ; Gramlich, Leah ; Raman, Maitreyi ; Alberda, Cathy ; Belland, Dawn ; Den Heyer, Vanessa ; Tandon, Puneeta ; Morgan, Marsha Yvonne .
In: Journal of Hepatology, 26.01.2022.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Predicted estimates of resting energy expenditure have limited clinical utility in patients with cirrhosis: an individual patient data analysis
AU - Limon-Miro, Ana Teresa
AU - Jackson, Clive Douglas
AU - Eslamparast, Tannaz
AU - Yamanaka-Okumura, Hisami
AU - Plank, Lindsay Dudley
AU - Henry, Christiani Jeyakumar
AU - Madden, Angela
AU - Ferreira, Livia Garcia
AU - Kalaitzakis, Evangelos
AU - Prieto de Frías, César
AU - Knudsen, Anne Wilkens
AU - Gramlich, Leah
AU - Raman, Maitreyi
AU - Alberda, Cathy
AU - Belland, Dawn
AU - Den Heyer, Vanessa
AU - Tandon, Puneeta
AU - Morgan, Marsha Yvonne
N1 - © 2022 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1016/j.jhep.2022.01.005
PY - 2022/1/26
Y1 - 2022/1/26
N2 - Background & Aim: Malnutrition is associated with adverse clinical outcomes in patients with cirrhosis. Accurate assessment of energy requirements is needed to optimize dietary intake. Resting energy expenditure (REE), the major component of total energy expenditure, can be measured using indirect calorimetry (mREE) or estimated using prediction equations (pREE). This study assessed the usefulness of predicted estimates of REE in this patient population. Methods: Individual mREE data were available for 900 patients with cirrhosis (mean [±1SD] age 55.7±11.6 yr; 70% men; 52% south-east Asian) and 282 healthy controls (mean age 36.0±12.8 yr; 52% men; 18% south-east Asian). Metabolic status was classified using thresholds based on the mean±1SD of the mREE in the healthy controls. Comparisons were made between mREE and pREE estimates obtained using the Harris-Benedict, Mifflin, Schofield and Henry equations. Stepwise regression was used to build three new prediction models which included sex, ethnicity, body composition measures, and MELD scores. Results: The mean mREE was significantly higher in patients than controls when referenced to dry body weight (22.43.8 cf. 20.82.6 kcal/kg/24hr; p<0.001); there were no significant sex differences. The mean mREE was significantly higher in Caucasian than Asian patients (23.1±4.4 cf. 21.7±2.9 kcal/kg/24hr; p<0.001). Overall, 37.1% of Caucasians and 25.3% of Asians were classified as hypermetabolic. The differences between mREE and pREE were both statistically and clinically relevant; in the total patient population, pREE estimates ranged from 501 kcal/24hr less to 548 kcal/24hr more than the mREE. Newly-derived prediction equations provided better estimates of mREE but still had limited clinical utility. Conclusions: Prediction equations do not provide useful estimates of REE in patients with cirrhosis. REE should be directly measured.
AB - Background & Aim: Malnutrition is associated with adverse clinical outcomes in patients with cirrhosis. Accurate assessment of energy requirements is needed to optimize dietary intake. Resting energy expenditure (REE), the major component of total energy expenditure, can be measured using indirect calorimetry (mREE) or estimated using prediction equations (pREE). This study assessed the usefulness of predicted estimates of REE in this patient population. Methods: Individual mREE data were available for 900 patients with cirrhosis (mean [±1SD] age 55.7±11.6 yr; 70% men; 52% south-east Asian) and 282 healthy controls (mean age 36.0±12.8 yr; 52% men; 18% south-east Asian). Metabolic status was classified using thresholds based on the mean±1SD of the mREE in the healthy controls. Comparisons were made between mREE and pREE estimates obtained using the Harris-Benedict, Mifflin, Schofield and Henry equations. Stepwise regression was used to build three new prediction models which included sex, ethnicity, body composition measures, and MELD scores. Results: The mean mREE was significantly higher in patients than controls when referenced to dry body weight (22.43.8 cf. 20.82.6 kcal/kg/24hr; p<0.001); there were no significant sex differences. The mean mREE was significantly higher in Caucasian than Asian patients (23.1±4.4 cf. 21.7±2.9 kcal/kg/24hr; p<0.001). Overall, 37.1% of Caucasians and 25.3% of Asians were classified as hypermetabolic. The differences between mREE and pREE were both statistically and clinically relevant; in the total patient population, pREE estimates ranged from 501 kcal/24hr less to 548 kcal/24hr more than the mREE. Newly-derived prediction equations provided better estimates of mREE but still had limited clinical utility. Conclusions: Prediction equations do not provide useful estimates of REE in patients with cirrhosis. REE should be directly measured.
U2 - 10.1016/j.jhep.2022.01.005
DO - 10.1016/j.jhep.2022.01.005
M3 - Article
JO - Journal of Hepatology
JF - Journal of Hepatology
SN - 0168-8278
ER -