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Resting energy expenditure in clinical pediatrics: measured versus prediction equations
A S Kaplan1, B S Zemel, K M Neiswender
1Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, PA 19104.
Insights
The Schofield weight and height equation best predicts resting energy expenditure (REE) in children with nutritional issues. However, measured REE is recommended due to significant variability in all prediction equations.
Area of Science:
- Pediatric Nutrition
- Metabolic Research
- Clinical Assessment
Background:
- Accurate assessment of resting energy expenditure (REE) is crucial for managing pediatric nutritional disorders.
- Existing prediction equations for REE may not accurately reflect the energy needs of children with clinical conditions.
Purpose of the Study:
- To compare the accuracy of various REE prediction equations against measured REE in children requiring clinical nutritional support.
- To identify the most reliable prediction equation for estimating REE in pediatric patients with failure to thrive or obesity.
Main Methods:
- Indirect calorimetry was used to measure REE in 102 pediatric patients (aged 0.2-20.5 years).
- Measured REE was compared with predictions from FAO/WHO/UNU, Harris-Benedict, and two Schofield equations (SCHO-WT, SCHO-HTWT).
- Patient cohort included children with failure to thrive (76%) and obesity (19%).
Main Results:
- The Schofield equation using weight and height (SCHO-HTWT) demonstrated the closest prediction to measured REE.
- SCHO-HTWT showed good accuracy for obese, failure to thrive, and infant populations.
- Overall, prediction equations accurately estimated REE in only approximately 40% of the study participants.
Conclusions:
- The SCHO-HTWT equation offers improved REE prediction for children with clinical nutritional problems compared to weight-only equations.
- Significant variability in REE measurements underscores the need for direct measurement in clinical practice.
- Direct measurement of REE is recommended when precise caloric expenditure data is essential for patient care.
Objective:
To evaluate the use of resting energy expenditure (REE) prediction equations compared with measured REE in children referred for REE to aid clinical care.
Subjects:
One hundred two patients, aged 0.2 to 20.5 years, 55% female, with a nutritional diagnosis of failure to thrive (76%), obesity (19%), or other (5%).
Methods:
We measured REE by indirect calorimetry and compared with prediction equations: Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU) equation, Harris-Benedict (H-B) equation, and two equations from Schofield, one using weight (SCHO-WT) and one using weight and height (SCHO-HTWT).
Results:
The SCHO-HTWT equation more closely predicted measured REE (100% +/- 19%), compared with the WHO equation (99% +/- 22%), the SCHO-WT equation, (99% +/- 21%), and the H-B equation (92% +/- 25%). The SCHO-HTWT equation was the best at predicting REE for obese subjects (95% +/- 17%), for those with failure to thrive (101% +/- 20%), and for children from birth to 3 years of age (101% +/- 23%). Nevertheless, the prediction equations closely predicted REE in only about 40% of subjects.
Conclusion:
These findings suggest that the SCHO-HTWT equation predicts REE in children with clinical nutritional problems better than equations that use weight alone. In view of the wide variability in REE measurements, however, we believe that REE should be measured in patients for whom knowledge of caloric expenditure is required for clinical care.