Should we measure or estimate energy expenditure in spinal cord injury patients? A comparison of indirect calorimetry and commonly used predictive equations
1Wong S, 1Subong P, 1Pandey A, 2Toumpi M, 1Saif M, 1Graham A
1National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, , United kingdom; 2The Health Lab, Athens, , Greece
Objectives: The objective of this study is to (1) measured 15-minutes energy expenditure to determine 24-hours RMR (m-RMR) using QUARK indirect calorimeter; (2) compare the m-RMR with estimated RMR (e-RMR) using predictive equations (Harris-Benedicts1, Mifflin-St. Jeor2, Oxford-Henry3 and Schofield equation4).
Mthods: 101 adult (65 SCI patients (32.1% tetraplegia; 48.5% complete SCI) and 36 able-bodied control subjects (median age: 41, range 18-75 years) had their RMR measured during October 14 to August 17.
Results: There were no difference in m-RMR, 1714 kcal/d (IQ range: 718), 1753 kcal/d (IQ range: 563) in SCI and control respectively. SCI group’s BMI was significantly higher than able-bodied control (3245 v 27.2 kg/m2, p<0.01). Predictive equations were found to be under- and over- estimated m-RMR in SCI patients by -38.8 to 77.9% (Harris-Benedict: 13.5%, p=0.002; Mifflin-St. Jeor: 6.7%, p=0.031; Oxford-Henry: 10.5%, p=0.008; Schofiled: 12.7%, p=0.003). No difference were found in body mass index (BMI) (32.2 v 33.2, p=0.54), m-RMR (1577 v 1640 kcal, p=0.552), VO2 (220 v 237 ml/min, p=0.516) and VCO2 (187 v 2004 ml/min, p=0.516) between tetraplegic group and paraplegic group. All 4 predictive equations were under- or over- estimated RMR in tetraplegic patients by -7.8 to 61.6% (Harris-Benedict: 20.5%, p=0.016; Mifflin-St. Jeor: 13.4%, p=0.042; Oxford-Henry: 16.5%, p=0.040 and; Schofiled: 19.5%, p=0.011). Apart from Schofield (p=0.03) and Harris-Benedict (p=0.02), no significant difference was observed when compared m-RMR and e-RMR in paraplegia patients.
Conclusions: Although predictive equations are sensitive to estimate RMR in able-bodied control, there is high variability in SCI patients, especially in tetraplegia. Our findings highlight the importance of IC to adequately estimate RMR in this vulnerable population. Given the limited resources constraint, tetraplegic patients who are at malnutrition-risk should have their RMR measured via indirect calorimeter when they admitted to SCI centre. Development of validated RMR equation in SCI population is warranted.
1. Harris JA & Benedict FG (1919) A Biometric Study of Basal Metabolism in Man, publication no. 270. Washington DC: Carnegie Institute of Washington.
2. Mifflin MD, et al (1990) Am J Clin Nutr 51, 241-247.
3. Henry C (2005) Public Health Nutr 8, 1133-1152.
4. Schofield W, et al (1985) Hum Nutr: Clin Nutr 39, 1-96.
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