Rationale for Determining Energy Requirement in Hospitalized Patients: A Narrative Review.

Area of Science:

• Clinical Nutrition
• Metabolism
• Medical Nutrition Therapy

Background:

• Malnutrition is prevalent in hospitalized patients, leading to adverse clinical outcomes.
• Adequate nutritional support is crucial for patient recovery and survival.
• Accurate estimation of energy requirements is fundamental for effective nutritional therapy.

Purpose of the Study:

• To review the physiological basis of energy requirements.
• To compare international guidelines for estimating energy expenditure in adult and pediatric patients.
• To highlight the importance of continuous monitoring and adjustment of nutritional support.

Main Methods:

• Narrative review of literature on energy expenditure.
• Discussion of components of total energy expenditure (TEE): basal metabolic rate (BMR), physical activity, thermic effect of food, growth, and disease impact.
• Comparison of recommendations from major international guidelines for adult and pediatric populations.

Main Results:

• Indirect calorimetry provides direct measurement of energy expenditure (EE) but is not always clinically feasible.
• Predictive equations based on basal metabolic rate (BMR) are commonly used alternatives.
• Guidelines offer varying recommendations for energy needs in different patient groups.

Conclusions:

• Accurate determination of energy requirements is essential for optimizing nutritional therapy in hospitalized patients.
• Predictive equations are a practical alternative to indirect calorimetry, but their limitations must be considered.
• Individualized nutritional support, with continuous monitoring and adjustments, is key to improving patient outcomes.