Estimating resting energy expenditure in patients requiring nutritional support: a survey of dietetic practice

Estimation of resting energy expenditure (REE) involves predicting basal metabolic rate (BMR) plus adjustment for metabolic stress. The aim of this study was to investigate the methods used to estimate REE and to identify the impact of the patient's clinical condition and the dietitians' work profile on the stress factor assigned. A random sample of 115 dietitians from the United Kingdom with an interest in nutritional support completed a postal questionnaire regarding the estimation of REE for 37 clinical conditions. The Schofield equation was used by the majority (99%) of dietitians to calculate BMR; however, the stress factors assigned varied considerably with coefficients of variation ranging from 18.5 (cancer with cachexia) to 133.9 (HIV). Dietitians specializing in gastroenterology assigned a higher stress factor to decompensated liver disease than those not specializing in gastroenterology (19.3 vs 10.7, P=0.004). The results of this investigation strongly suggest that there is wide inconsistency in the assignment of stress factors within specific conditions and gives rise to concern over the potential consequences in terms of under- or overfeeding that may ensue.