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Published on: June 16, 2014
Estimating Total Energy Expenditure to Determine Energy Requirements in Free-Living Children With Stage 3 Chronic
Caroline E Anderson1, Rodney D Gilbert2, Matthew Harmer3
1Department of Nutrition and Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK; The NIHR Southampton Biomedical Research Centre, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Dietetic Programme, Faculty of Health and Wellbeing, University of Winchester, Winchester, UK.
Insights
Total energy expenditure and physical activity energy expenditure did not differ between children with chronic kidney disease and healthy controls. Simple clinical assessments are sufficient for prescribing energy needs in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
- Metabolic Research
Background:
- Malnutrition and obesity are significant challenges in pediatric chronic kidney disease (CKD) management, impacting growth and treatment response.
- Accurate assessment of total energy expenditure (TEE) and energy requirements is crucial but poorly defined in pediatric CKD.
- Current clinical practices for nutritional interventions in pediatric CKD are varied and lack definitive guidance.
Purpose of the Study:
- To explore a practical approach for guiding nutritional interventions in pediatric CKD.
- To measure TEE and physical activity energy expenditure (PAEE) in children with CKD and healthy controls.
- To investigate the relationship between TEE, PAEE, and kidney function (eGFR).
Main Methods:
- A cross-sectional prospective study comparing 18 children with CKD (stage 3) and 20 healthy controls (ages 6-17).
- TEE and PAEE were measured using basal metabolic rate (BMR), activity diaries, and doubly labeled water (DLW) in healthy subjects.
- Results were analyzed in relation to estimated glomerular filtration rate (eGFR).
Main Results:
- No significant differences in TEE and PAEE were observed between children with CKD and controls, even after adjustments for covariates.
- TEE values ranged from 1927 to 2330 kcal/d, with physical activity levels (PAL) between 1.52 and 1.71.
- Alternative methods for measuring TEE showed good agreement with DLW in healthy children, with minor discrepancies in specific factorial methods.
Conclusions:
- Structured clinical approaches utilizing weight, height, BMI, predictive BMR or TEE values, and activity assessment are adequate for initial energy prescriptions in most pediatric CKD patients.
- These practical methods can guide nutritional interventions, addressing the challenges of malnutrition and obesity in pediatric CKD.
- Further research can refine these practical approaches for optimizing growth and well-being in children with CKD.
Objective:
Malnutrition and obesity are complex burdensome challenges in pediatric chronic kidney disease (CKD) management that can adversely affect growth, disease progression, wellbeing, and response to treatment. Total energy expenditure (TEE) and energy requirements in children are essential for growth outcomes but are poorly defined, leaving clinical practice varied and insecure. The aims of this study were to explore a practical approach to guide prescribed nutritional interventions, using measurements of TEE, physical activity energy expenditure (PAEE), and their relationship to kidney function.
Design And Methods:
In a cross-sectional prospective age-matched and sex-matched controlled study, 18 children with CKD (6-17 years, mean stage 3) and 20 healthy, age-matched, and gender-matched controls were studied. TEE and PAEE were measured using basal metabolic rate (BMR), activity diaries and doubly labeled water (healthy subjects). Results were related to estimated glomerular filtration rate (eGFR). The main outcome measure was TEE measured by different methods (factorial, doubly labeled water, and a novel device).
Results:
Total energy expenditure and PAEE with or without adjustments for age, gender, weight, and height did not differ between the groups and was not related to eGFR. TEE ranged from 1927 ± 91 to 2330 ± 73 kcal/d; 95 ± 5 to 109 ± 5% estimated average requirement (EAR), physical activity level (PAL) 1.52 ± 0.01 to 1.71 ± 0.17, and PAEE 24 to 34% EAR. Comparisons between DLW and alternative methods in healthy children did not differ significantly, except for 2 (factorial methods and a fixed PAL; and the novel device).
Conclusion:
In clinical practice, structured approaches using supportive evidence (weight, height, BMI sds), predictive BMR or TEE values and simple questions on activity, are sufficient for most children with CKD as a starting energy prescription.
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