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Measures of Total Energy Expenditure and Its Components Using the Doubly Labeled Water Method in Rehabilitating Burn
Kathy Prelack1,2, Yong Ming Yu1,2, Maggie Dylewski1
11 Shriners Hospitals for Children, Boston, Massachusetts, USA.
Insights
Total energy expenditure (TEE) and resting energy expenditure (REE) in pediatric burn patients during rehabilitation are similar to reference standards. Increased activity energy expenditure (AEE) is a key factor in their accelerated metabolism.
Area of Science:
- Pediatric critical care
- Metabolic research
- Burn injury recovery
Background:
- Burn injuries can cause persistent hypermetabolism, potentially delaying growth and anabolism in children.
- Clinical observations suggested resting energy expenditure (REE) might not be elevated during the rehabilitative phase, prompting further investigation.
- Understanding energy expenditure components is crucial for optimizing recovery in pediatric burn patients.
Purpose of the Study:
- To measure total energy expenditure (TEE) and its components in rehabilitating pediatric burn patients.
- To identify the factors contributing to accelerated energy metabolism in this population.
- To compare energy expenditure metrics with established reference standards.
Main Methods:
- Prospective descriptive study involving pediatric burn patients with burns ≥20% total body surface area (TBSA).
- Total energy expenditure (TEE) measured using the doubly labeled water method over 7 days.
- Resting energy expenditure (REE) assessed via indirect calorimetry; activity energy expenditure (AEE) monitored with a physical activity device.
Main Results:
- Ten children with an average burn size of 53.7% TBSA completed the study.
- Daily TEE averaged 66 kcal/kg, comparable to reference Dietary Reference Intakes (DRI).
- Resting energy expenditure (REE) was 92% ± 25% of predicted basal metabolic rate, not exceeding 120% in any patient.
Conclusions:
- Total energy expenditure (TEE) and resting energy expenditure (REE) in rehabilitating pediatric burn patients align with reference standards.
- Elevated REE was not a common finding; however, high activity energy expenditure (AEE) was frequently observed.
- Activity energy expenditure (AEE) appears to be a significant contributor to the overall energy demands in this patient group.
Background:
A persistent hypermetabolic state delays anabolism and growth in burned children. However, our own clinical experience has been that resting energy expenditure (REE) is not increased during the rehabilitative phase, suggesting other contributing factors. We measured total energy expenditure (TEE) and its components in rehabilitating pediatric burn patients to identify the basis for accelerated energy metabolism in this population.
Materials And Methods:
Children admitted with initial burns of 20% of their total body surface area (TBSA) or greater were enrolled into this prospective, descriptive study. TEE was measured using the doubly labeled water method over a 7-day period. During that period, REE was measured on 2 days by indirect calorimetry. Activity energy expenditure (AEE) was assessed using a physical activity monitoring device for a 24-hour period. TEE and REE were compared with sex-specific, age-matched, and weight-matched norms using the Dietary Reference Intakes (DRI) standards.
Results:
Ten children with an average burn size of 53.7% ± 20% (range, 27%-82%) of TBSA completed this study. Their mean age and weight were 10.4 ± 5.5 years and 35.8 ± 16.4 kg, respectively. Daily TEE averaged 66 kcal/kg and was 1.08% of reference DRI. REE was 92% ± 25% of predicted basal metabolic rate, not exceeding 120% as a maximum value in any child.
Conclusions:
TEE and REE in rehabilitating burn children are comparable to reference standards. Increased REE was not typical in our population, but measures of AEE were commonly high.
