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Energy requirements and body composition in stable pediatric intensive care patients receiving ventilatory support
Jonathan C K Wells1, Quen Mok, Andrew W Johnson
1MRC Childhood Nutrition Research Centre, Institute of Child Health, London, UK.
Insights
Pediatric intensive-care patients on ventilators have lower energy needs than healthy children. Their weight gain is higher in fat due to reduced activity and muscle mass, impacting nutritional strategies.
Area of Science:
- Pediatric critical care medicine
- Human physiology
- Nutritional science
Background:
- Accurately assessing energy requirements in pediatric intensive-care patients is challenging.
- Understanding energy expenditure is crucial for optimizing nutrition and growth in critically ill children.
Purpose of the Study:
- To investigate energy expenditure and body composition in stable pediatric intensive-care patients receiving long-term ventilatory support.
- To compare these metrics with those of healthy children.
Main Methods:
- Utilized the doubly-labeled water method to measure total energy expenditure and total body water in 10 pediatric patients.
- Body composition was assessed in relation to patient length.
Main Results:
- Patients exhibited significantly lower total energy expenditure compared to healthy children of similar age.
- Fat-free mass deposition was reduced, while fat deposition was increased relative to length.
- Despite similar weight gain to healthy peers, the composition of weight gain was disproportionately fat.
Conclusions:
- Total energy requirements are generally reduced in these pediatric patients due to lower activity and muscle mass.
- Nutritional management should consider the altered body composition, characterized by increased fat deposition.
- Individual variations exist, as seen in a patient with myofibromatosis.
Abstract:
Energy requirements of pediatric intensive-care patients are unknown due to the difficulty of measuring total energy expenditure in free-living conditions. We investigated energy expenditure and body composition in stable pediatric intensive-care patients receiving long-term ventilatory support. Total energy expenditure and total body water were measured in 10 such patients using the doubly-labeled water method. The patients had significantly lower energy expenditure than healthy children of the same age. Relative to length, fat-free mass deposition was significantly lower, and fat deposition was significantly greater, than in healthy subjects. In general, total energy requirements of these patients are significantly reduced as compared to healthy children, which can be attributed to their lower activity levels and their reduced muscle mass. Although they gain weight similar to healthy children, their weight gain is disproportionately higher in fat. However, one patient with myofibromatosis contradicted this general pattern.