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Physical activity as a determinant of total energy expenditure in critically ill children
Martijn van der Kuip1, Kees de Meer, Klaas R Westerterp
1Department of Paediatrics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. m.vanderkuip@vumc.nl
Insights
Critically ill children require accurate energy expenditure tracking. Physical activity significantly contributes to total energy needs, so activity-related energy expenditure must be considered to prevent malnutrition.
Area of Science:
- Pediatric critical care medicine
- Human nutrition and metabolism
- Clinical research methodology
Background:
- Accurate nutritional support for critically ill children necessitates understanding their energy expenditure.
- Resting energy expenditure (REE) measured by metabolic monitors may underestimate total energy expenditure (TEE) in clinical practice.
- The relationship between REE, TEE, and physical activity in critically ill children requires further investigation.
Purpose of the Study:
- To investigate total energy expenditure (TEE) in critically ill children.
- To compare TEE with resting energy expenditure (REE) measured by metabolic monitors.
- To determine the relationship between physical activity and energy expenditure during critical illness and initial recovery.
Main Methods:
- Twenty pediatric patients (0-16 years) with sepsis or post-surgery were enrolled.
- Total energy expenditure (TEE) was measured using doubly labeled water during the first week post-admission.
- Resting energy expenditure (REE) was measured daily using a metabolic monitor, and physical activity was assessed via tri-axial accelerometry.
Main Results:
- Resting energy expenditure (REE) was comparable to predicted basal metabolic rates but was 20% lower than total energy expenditure (TEE) (P=0.006).
- The overall physical activity level (TEE/REE) was 1.22 (95% CI: 1.08-1.36).
- Activity-related energy expenditure demonstrated a significant association with accelerometry recordings (R²=0.72, P=0.02).
Conclusions:
- In critically ill children admitted to the pediatric intensive care unit, activity-related energy expenditure is a significant component of total energy needs.
- Accounting for physical activity is crucial to prevent negative energy balance in individual pediatric patients.
- Standard resting energy expenditure measurements may not fully capture the energy demands of critically ill children.
Background & Aims:
For adequate nutritional support of critically ill children, knowledge of the patient's energy expenditure is required. Steady state measurement by a metabolic monitor are defined as resting energy expenditure and may underestimate total energy expenditure in clinical practise. The aim of this study was to investigate total energy expenditure, resting energy expenditure and the relation with physical activity during critical illness and initial recovery.
Methods:
We enrolled 20 patients (0-16 yr) with sepsis or following surgery. During the first week following admission, total energy expenditure was measured with doubly labelled water, and compared with daily resting energy expenditure measurements (metabolic monitor). Activity levels were independently determined by tri-axial accelerometry.
Results:
Resting energy expenditure was not different from Schofield's predicted basal metabolic rate, but was 20% lower than total energy expenditure (P=0.006). Overall physical activity level (=total energy expenditure divided by resting energy expenditure) was 1.22 (95%CI: 1.08-1.36) and activity related energy expenditure (=total energy expenditure minus resting energy expenditure) was associated with accelerometry recordings (R(2)=0.72, P=0.02).
Conclusions:
During the week following pediatric intensive care admission, in the individual critically ill patient, activity related energy expenditure should be taken into account to prevent a negative energy balance.
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