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Resting energy expenditure measured longitudinally following hip fracture compared to predictive equations: is an injury adjustment required?

Published online by Cambridge University Press:  08 March 2007

Michelle D. Miller ,
Lynne A. Daniels ,
Elaine Bannerman  and
Maria Crotty
Michelle D. Miller
Affiliation:
Flinders Centre for Clinical Change and Health Care Research, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia, Australia
Lynne A. Daniels
Affiliation:
Flinders Centre for Clinical Change and Health Care Research, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia, Australia Flinders University, Department of Nutrition and Dietetics, FMC Flats, Flinders Drive, Bedford Park, South Australia, Australia
Elaine Bannerman
Affiliation:
Flinders University, Department of Nutrition and Dietetics, FMC Flats, Flinders Drive, Bedford Park, South Australia, Australia
Maria Crotty*
Affiliation:
Flinders Centre for Clinical Change and Health Care Research, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia, Australia
*
*Corresponding author: Dr Maria Crotty, fax +61 8 82751130, email [email protected]
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Abstract

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The present study measuring resting energy expenditure (REE; kJ/d) longitudinally using indirect calorimetry in six elderly women aged ≥70 years following surgery for hip fracture, describes changes over time (days 10, 42 and 84 post-injury) and compares measured values to those calculated from routinely applied predictive equations. REE was compared to REE predicted using the Harris Benedict and Schofield equations, with and without accounting for the theoretical increase in energy expenditure of 35 % secondary to physiological stress of injury and surgery. Mean (95 % CI) measured REE (kJ/d) was 4704 (4354, 5054), 4090 (3719, 4461) and 4145 (3908, 4382) for days 10, 42 and 84, respectively. A time effect was observed for measured REE, P=0·003. Without adjusting for stress the mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Harris Benedict equation were 1 (−9, 12), 10 (2, 18) and 9 (1, 17) for days 10, 42 and 84, respectively. The mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Schofield equation without adjusting for stress were 8 (−3, 19), 16 (6, 26) and 16 (10, 22) for days 10, 42 and 84, respectively. After adjusting for stress, REE predicted from the Harris Benedict or Schofield equations overestimated measured REE by between 38 and 69 %. Energy expenditure following fracture is poorly understood. Our data suggest REE was relatively elevated early in recovery but declined during the first 6 weeks. Using the Harris Benedict or Schofield equations adjusted for stress may lead to overestimation of REE in the clinical setting. Further work is required to evaluate total energy expenditure before recommendations can be made to alter current practice for calculating theoretical total energy requirements of hip fracture patients.

Keywords

Energy metabolismNutritionOrthopaedicsRehabilitation
Type
Research Article
Information
British Journal of Nutrition , Volume 94 , Issue 6 , December 2005 , pp. 976 - 982
Copyright
Copyright © The Nutrition Society 2005

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