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Resting energy expenditure and prediction equations in young children with failure to thrive
T A Sentongo1, A M Tershakovec, M R Mascarenhas
1Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
Accurate measurement of resting energy expenditure (REE) is crucial for children with failure to thrive (FTT). The Schofield weight- and height-based equation is the most reliable predictor when direct measurement isn't possible.
Area of Science:
- Pediatrics
- Nutritional Science
- Metabolic Research
Background:
- Failure to thrive (FTT) in young children (birth to 3 years) necessitates accurate assessment of nutritional needs.
- Resting energy expenditure (REE) is a key component of caloric requirements.
Purpose of the Study:
- To compare predicted versus measured REE in young children diagnosed with FTT.
- To identify the most accurate predictive equation for REE in this population.
Main Methods:
- Measured REE using indirect calorimetry in 45 children with FTT.
- Compared measured REE against predictions from WHO, Schofield weight-based (SCH-WT), and Schofield weight- and height-based (SCH-WT-HT) equations.
- Examined clinical factors associated with prediction inaccuracies.
Main Results:
- All prediction equations showed less than 50% accuracy within 10% of measured REE.
- The SCH-WT-HT equation demonstrated no significant difference from measured REE (450 +/- 138 vs 438 +/- 111 kcal/d, P =.2).
- Younger age and more severe FTT correlated with underestimation of REE by predictive equations.
Conclusions:
- Direct measurement of REE is recommended for infants and children with moderate to severe FTT requiring precise caloric management.
- The SCH-WT-HT equation is the preferred method for estimating REE when direct measurement is not feasible, as it is least likely to underestimate needs.
Objective:
To compare predicted and measured resting energy expenditure (REE) in young children (birth to 3 years) with failure to thrive (FTT).
Methods:
REE (kcal/d) was measured by indirect calorimetry and compared with predicted REE from 3 sex and age group equations: World Health Organization (WHO), Schofield weight-based (SCH-WT), and Schofield weight- and height-based (SCH-WT-HT). The clinical characteristics associated with inaccuracy of predicted REE were examined.
Results:
Forty-five subjects (47% female) were evaluated. Their clinical characteristics (mean +/- SD) included age 1.2 +/- 0.7 years, length/height z score -2.1 +/- 1.3, weight z score -2.7 +/- 1.0, and measured REE 438 +/- 111 kcal/d. All prediction equations were within 10% accuracy <50% of the time. However, SCH-WT-HT did not significantly differ from measured REE (450 +/- 138 vs 438 +/- 111 kcal/d, P =.2) and was least likely to underestimate REE. Younger age and more severe growth failure (based on weight, length/height, or both) were associated with underestimation of REE by prediction equations.
Conclusion:
REE should be measured in young infants and children with moderate to severe FTT when knowledge of caloric needs is required for optimal clinical care. The SCH-WT-HT equation was least likely to underestimate REE and is therefore preferred when REE cannot be measured in this group of children.