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Energy expenditure in children undergoing hematopoietic stem cell transplantation
K A Ringwald-Smith1, H E Heslop, R A Krance
1Clinical Nutrition Services, Department of Hematology-Oncology, University of Tennessee, College of Medicine, Memphis, TN, USA.
Insights
Pediatric hematopoietic stem cell transplantation (HSCT) patients have energy needs that standard equations do not accurately predict. Indirect calorimetry is recommended for precise energy expenditure assessment during HSCT.
Area of Science:
- Pediatric oncology
- Clinical nutrition
- Transplantation medicine
Background:
- Patients undergoing hematopoietic stem cell transplantation (HSCT) for malignancy often have elevated nutritional requirements.
- Accurate estimation of energy expenditure is crucial for optimizing nutritional support in these vulnerable patients.
Purpose of the Study:
- To evaluate the accuracy of common energy estimation equations in predicting the measured energy expenditure (MEE) of pediatric patients undergoing HSCT.
- To determine if energy requirements change throughout the HSCT period.
Main Methods:
- Prospective study comparing estimated energy expenditure (EEE) with MEE in 40 pediatric HSCT patients at four time-points.
- MEE was measured using indirect calorimetry.
- Data from 34 patients were analyzed.
Main Results:
- Standard energy estimation equations (WHO, Seashore, Harris-Benedict) inaccurately predicted MEE in pediatric HSCT patients at most time-points.
- The World Health Organization equation was only accurate on day 14 post-HSCT.
- Measured energy expenditure varied significantly during the transplant period, peaking on day 14.
Conclusions:
- Current energy estimation equations are unreliable for pediatric HSCT patients.
- Indirect calorimetry is a medically warranted tool for accurate energy expenditure assessment in this population.
- Further research is needed to develop precise equations for estimating nutritional needs during HSCT.
Abstract:
Prior studies suggest that patients undergoing hematopoietic stem cell transplantation (HSCT) for malignancy have nutritional needs that are greater than their estimated needs. To determine whether energy estimation equations accurately predict energy expenditure of pediatric patients undergoing HSCT, we prospectively compared the estimated energy expenditure (EEE) and measured energy expenditure (MEE) of 40 patients at four time-points. We also investigated whether energy requirements changed during the transplant period. MEE was determined by indirect calorimetry. Data from 34 patients (autologous HSCT = 10, allogeneic HSCT = 24) were sufficient for analysis. The World Health Organization equation adequately approximated MEE only on day 14 after HSCT. At all other time-points, measured energy expenditure was significantly less than estimated energy expenditure obtained by using the WHO equation (applicable to all patients), the Seashore equation (for patients <15 years of age; n = 19), or the Harris-Benedict equation (for patients > or =15 years of age; n = 15). The median measured energy expenditure varied significantly over the study period and was greatest on day 14 after HSCT. Until accurate equations have been identified for estimating these patients' needs, the use of indirect calorimetry may be medically warranted.