A new predictive equation for resting energy expenditure in healthy individuals.

Background An assessment of energy needs is a necessary component in the development and evaluation of a nutrition care plan. The metabolic rate can be measured or estimated by equations, but estimation is by far the more common method. However, predictive equations might generate errors large enough to impact outcome. Therefore, a systematic review of the literature was undertaken to document the accuracy of predictive equations preliminary to deciding on the imperative to measure metabolic rate. Methods As part of a larger project to determine the role of indirect calorimetry in clinical practice, an evidence team identified published articles that examined the validity of various predictive equations for resting metabolic rate (RMR) in nonobese and obese people and also in individuals of various ethnic and age groups. Articles were accepted based on defined criteria and abstracted using evidence analysis tools developed by the American Dietetic Association. Because these equations are applied by dietetics practitioners to individuals, a key inclusion criterion was research reports of individual data. The evidence was systematically evaluated, and a conclusion statement and grade were developed. Results Four prediction equations were identified as the most commonly used in clinical practice (Harris-Benedict, Mifflin-St Jeor, Owen, and World Health Organization/Food and Agriculture Organization/United Nations University [WHO/FAO/UNU]). Of these equations, the Mifflin-St Jeor equation was the most reliable, predicting RMR within 10% of measured in more nonobese and obese individuals than any other equation, and it also had the narrowest error range. No validation work concentrating on individual errors was found for the WHO/FAO/UNU equation. Older adults and US-residing ethnic minorities were underrepresented both in the development of predictive equations and in validation studies. Conclusions The Mifflin-St Jeor equation is more likely than the other equations tested to estimate RMR to within 10% of that measured, but noteworthy errors and limitations exist when it is applied to individuals and possibly when it is generalized to certain age and ethnic groups. RMR estimation errors would be eliminated by valid measurement of RMR with indirect calorimetry, using an evidence-based protocol to minimize measurement error. The Expert Panel advises clinical judgment regarding when to accept estimated RMR using predictive equations in any given individual. Indirect calorimetry may be an important tool when, in the judgment of the clinician, the predictive methods fail an individual in a clinically relevant way. For members of groups that are greatly underrepresented by existing validation studies of predictive equations, a high level of suspicion regarding the accuracy of the equations is warranted.

Comparison of Predictive Equations for Resting Metabolic Rate in Healthy Nonobese and Obese Adults: A Systematic Review

BACKGROUND AND AIMS
No gold standard exists for nutritional screening/assessment. This cross-sectional study aimed to collect/use a comprehensive set of clinical, anthropometric, functional data, explore interrelations, and derive a feasible/sensitive/specific method to assess nutritional risk and status in hospital practice.


PATIENTS AND METHODS
100 surgical patients were evaluated, 49M:51F, 55 +/- 18.9 (18-88) years. Nutritional risk assessment: Kondrup's Nutritional Risk Assessment, BAPEN's Malnutrition Screening Tool, Nutrition Screening Initiative, Admission Nutritional Screening Tool. Nutritional status: anthropometry categorised by Body Mass Index and McWhirter & Pennington criteria, recent weight loss > 10%, dynamometry, Subjective Global Assessment.


RESULTS
There was a strong agreement between all nutritional risk (k = 0.69-0.89, p < 0.05) and between all nutritional assessment methods (k = 0.51-0.88, p < or = 0.05) except for dynamometry. Weight loss > 10% was the only method that agreed with all tools (k = 0.86-0.94, p < or = 0.05), and was thereafter used as the standard. Kondrup's Nutritional Risk Assessment and Admission Nutritional Screening Tool were unspecific but highly sensitive (> or = 95%). Subjective Global Assessment was highly sensitive (100%) and specific (69%), and was the only method with a significant Youden value (0.7).


CONCLUSIONS
Kondrup's Nutritional Risk Assessment and Admission Nutritional Screening Tool emerged as sensitive screening methods; the former is simpler to use, Kondrup's Nutritional Risk Assessment has been devised to direct nutritional intervention. Recent unintentional weight loss > 10% is a simple method whereas Subjective Global Assessment identified high-risk/undernourished patients.

Nutritional risk and status assessment in surgical patients: a challenge amidst plenty.

Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation.

Background.
We aimed to determine the effect of dietary counseling or oral supplements on outcome for patients with cancer, specifically, nutritional outcome, morbidity, and quality of life (QOL), during and 3 months after radiotherapy.

Methods.
Seventy-five patients with head and neck cancer who were referred for radiotherapy (RT) were randomized to the following groups: group 1 (n = 25), patients who received dietary counseling with regular foods; group 2 (n = 25), patients who maintained usual diet plus supplements; and group 3 (n = 25), patients who maintained intake ad lib. Nutritional intake (determined by diet history) and status (determined by Ottery's Subjective Global Assessment), and QOL (determined by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 [EORTC QLQ-C30]) were evaluated at baseline, at the end of RT, and at 3 months.

Results.
Energy intake after RT increased in both groups 1 and 2 (p ≤ .05). Protein intake also increased in both groups 1 and 2 (p ≤ .006). Both energy and protein intake decreased significantly in group 3 (p 90% of patients experienced RT toxicity; this was not significantly different between groups, with a trend for reduced symptomatology in group 1 versus group 2/group 3 (p < .07). At 3 months, the reduction of incidence/severity of grade 1+2 anorexia, nausea/vomiting, xerostomia, and dysgeusia was different: 90% of the patients improved in group 1 versus 67% in group 2 versus 51% in group 3 (p < .0001). After RT, QOL function scores improved (p < .003) proportionally with improved nutritional intake and status in group 1/group 2 (p < .05) and worsened in group 3 (p < .05); at 3 months, patients in group 1 maintained or improved overall QOL, whereas patients in groups 2 and 3 maintained or worsened overall QOL.

Conclusions.
During RT, nutritional interventions positively influenced outcomes, and counseling was of similar/higher benefit; in the medium term, only counseling exerted a significant impact on patient outcomes. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005

Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy

A reappraisal of the caloric requirements of men.

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A reappraisal of the caloric requirements of men.