Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T05:17:38.010Z Has data issue: false hasContentIssue false
  • English
  • Français

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]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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

References

Avenell, A & Handoll, HHG (2005) Nutritional supplementation for hip fracture aftercare in older people. The Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001880. DOI: 10.1002/14651858. CD001880. pub3CrossRefGoogle Scholar
Bales, C & Ritchie, C (2004) Handbook of Clinical Nutrition and Aging. Totowa, NJ: Humana Press.CrossRefGoogle Scholar
Bastow, MD, Rawlings, J & Allison, SP (1983) Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism?. Lancet 1, 143–146.CrossRefGoogle ScholarPubMed
Bean, N, Redden, J, Goode, H, Grimble, G & Allison, SP (1994) Double-blind pilot trial, in elderly women with fractured femur, of ornithine alpha-ketoglutarate v. a defined formula oral supplement. Proc Nutr Soc 53, 203A.Google Scholar
Bland, JM & Altman, DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1, 307–310.CrossRefGoogle ScholarPubMed
Bleda, MJ, Bolibar, I, Pares, R & Salva, A (2002) Reliability of the mini nutritional assessment (MNA) in institutionalized elderly people. J Nutr Health Aging 6, 134–137.Google ScholarPubMed
Bonjour, JP, Ammann, P, Chevalley, T & Rizzoli, R (2001) Protein intake and bone growth. Can J Appl Physiol 26, S153–S166.CrossRefGoogle ScholarPubMed
Brown, KM & Seabrook, NA (1992) Nutritional influences on recovery and length of hospital stay in elderly women following femoral fracture. Proc Nutr Soc 51, 132A.Google Scholar
Campillo, B, Bories, PN, Devanlay, M, Pornin, B, Le Parco, J-C, Gaye-Bareyt, E & Fouet, P (1992) Aging, energy expenditure and nutritional status: evidence for denutrition-related hypermetabolism. Ann Nutr Metab 36, 265–272.CrossRefGoogle ScholarPubMed
Case, KO, Brahler, CJ & Heiss, C (1997) Resting energy expenditures in Asian women measured by indirect calorimetry are lower than expenditures calculated from prediction equations. J Am Diet Assoc 97, 1288–1292.CrossRefGoogle ScholarPubMed
Chumlea, WC, Hall, G, Lilly, F, Siervogel, RM & Guo, SS (1999) The Mini Nutritional Assessment and body composition in healthy adults. Nestle Nutr Workshop Ser Clin Perform Program 1, 13–22.CrossRefGoogle ScholarPubMed
Chumlea, WC, Roche, AF & Steinbaugh, ML (1985) Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc 33, 116–120.CrossRefGoogle ScholarPubMed
Crowder, MJ & Hand, DJ (1990) The Analysis of Repeated Measures. London: Chapman and Hall.Google Scholar
Daly, JM, Heymsfield, SB, Head, CA, Harvey, LP, Nixon, DW & Grossman, GD (1985) Human energy requirements: overestimation by widely used prediction equation. Am J Clin Nutr 42, 1170–1174.CrossRefGoogle ScholarPubMed
de Weir, JBV (1949) New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol 109, 1–9.CrossRefGoogle Scholar
Delmi, M, Rapin, C-H, Bengoa, J-M, Delmas, P, Vasey, H & Bonjour, J-P (1990) Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 335, 1013–1016.CrossRefGoogle ScholarPubMed
FAO/WHO/UNU (1985) Energy and Protein Requirements. Technical Report Series no. 724. Geneva: WHO.Google Scholar
Foster, GD, Wadden, TA & Mullen, JL (1988) Resting energy expenditure, body composition, and excess weight in the obese. Metabolism: Clin Exp 37, 467–472.Google Scholar
Foster, MR, Heppenstall, RB, Friedenberg, ZB & Hozack, WJ (1990) A prospective assessment of nutritional status and complications in patients with fractures of the hip. J Orthop Trauma 4, 49–57.CrossRefGoogle ScholarPubMed
Guigoz, Y, Vellas, B & Garry, PJ (1994) Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol Suppl. 2, 15–60.Google Scholar
Gullberg, B, Johnell, O & Kanis, JA (1997) World-wide projections for hip fracture. Osteoporos Int 7, 407–413.CrossRefGoogle ScholarPubMed
Haentjens, P, Autier, P, Barette, M & Boonen, S (2001) The economic cost of hip fractures among elderly women. J Bone Joint Surg (Am) 83, 493–506.CrossRefGoogle ScholarPubMed
Harris, JA & Benedict, FG (1919) Biometric Studies of Basal Metabolism in Man. Washington, DC: Carnegie Institution of Washington.Google Scholar
Jallut, D, Tappy, L, Kohut, M, Bloesch, D, Munger, R, Schutz, Y, Chiolero, R, Felber, J-P, Livio, J-J & Jequier, E (1990) Energy balance in elderly patients after surgery for a femoral neck fracture. JPEN J Parenter Enteral Nutr 14, 563–568.CrossRefGoogle ScholarPubMed
Johnell, O, Kanis, JA, Oden, A, Sernbo, I, Redlund-Johnell, I, Petterson, C, De Laet, C & Jonsson, B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15, 38–42.CrossRefGoogle ScholarPubMed
Lawrence, M, Thongprasert, K & Durnin, JVGA (1988) Between-group differences in basal metabolic rates: an analysis of data collected in Scotland, The Gambia and Thailand. Eur J Clin Nutr 42, 877–891.Google ScholarPubMed
Long, CL, Schaffel, N, Geiger, JW, Schiller, WR & Blakemore, WS (1979) Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN J Parenter Enteral Nutr 3, 452–456.CrossRefGoogle ScholarPubMed
Luhrmann, PM & Neuhaeuser, BM (2004) Are the equations published in literature for predicting resting metabolic rate accurate for use in the elderly?. J Nutr Health Aging 8, 144–149.Google ScholarPubMed
Lumbers, M, New, SA, Gibson, S & Murphy, MC (2001) Nutritional status in elderly female hip fracture patients: comparison with an age-matched home living group attending day centres. Br J Surg 85, 733–740.Google ScholarPubMed
Mahan, LK & Escott-Stump, S, (editors) (2000) Krause's Food, Nutrition, & Diet Therapy, 10th ed, Philadelphia: W.B. Saunders Company.Google Scholar
McNeil, G, Rivers, JPW, Payne, PR, de Britto, JJ & Abel, R (1987) Basal metabolic rate of Indian men: no evidence of metabolic adaptation to a low plane of nutrition. Hum Nutr: Clin Nutr 41, 473–483.Google Scholar
Marottoli, RA, Berkman, LF & Cooney, LM (1992) Decline in physical function following hip fracture. J Am Geriatr Soc 40, 861–866.CrossRefGoogle ScholarPubMed
Melton, LJ (2003) Adverse outcomes of osteoporotic fractures in the general population. J Bone Min Res 18, 1139–1141.CrossRefGoogle ScholarPubMed
Mifflin, MD, St Jeor, ST, Hill, LA, Scott, BJ, Daugherty, SA & Koh, YO (1990) A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr 51, 241–247.CrossRefGoogle ScholarPubMed
Nelson, KM, Richards, EW, Long, CL, Martin, KR, Geiger, JW, Brooks, SW, Gandy, RE & Blakemore, WS (1995) Protein and energy balance following femoral neck fracture in geriatric patients. Metabolism: Clin Exp 44, 59–66.CrossRefGoogle ScholarPubMed
Older, MWJ, Edwards, D & Dickerson, JWT (1980) A nutrient survey in elderly women with femoral neck fractures. Br J Surg 67, 884–886.CrossRefGoogle ScholarPubMed
Owen, OE, Holup, JL & D'Alessio, DA (1987) A reappraisal of the calorie requirements of men. Am J Clin Nutr 46, 875–885.CrossRefGoogle Scholar
Owen, OE, Kavle, E, Owen, RS, Polansky, M, Caprio, S, Mozzoli, MA, Kendrick, ZV, Bushman, MC & Boden, G (1986) A reappraisal of caloric requirements in healthy women. Am J Clin Nutr 44, 1–9.CrossRefGoogle ScholarPubMed
Paillaud, E, Bories, P-N, Le Parco, J-C & Campillo, B (2000) Nutritional status and energy expenditure in elderly patients with recent hip fracture during a 2-month follow-up. Br J Nutr 83, 97–103.CrossRefGoogle ScholarPubMed
Patterson, BM, Cornell, CN, Carbone, B, Levine, B & Chapman, D (1992) Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg (Am) 74A, 251–260.CrossRefGoogle Scholar
Persson, MD, Brismar, KE, Katzarski, KS, Nordenstrom, J & Cederholm, TE (2002) Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. J Am Geriatr Soc 50, 1996–2002.CrossRefGoogle ScholarPubMed
Ponzer, S, Tidermark, J, Brismar, K, Soderqvist, A & Cederholm, T (1999) Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures. Clin Nutr 18, 241–246.CrossRefGoogle ScholarPubMed
Reeves, MM & Capra, S (2003 a) Predicting energy requirements in the clinical setting: are current methods evidence based?. Nutr Rev 61, 143–151.CrossRefGoogle ScholarPubMed
Reeves, MM & Capra, S (2003 b) Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice. Eur J Clin Nutr 57, 1530–1535.CrossRefGoogle ScholarPubMed
Rolandelli, RH & Ullrich, JR (1994) Nutritional support in the frail elderly surgical patient. Surg Clin North Am 74, 79–92.CrossRefGoogle ScholarPubMed
Schofield, W (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr: Clin Nutr 39, 5–41.Google ScholarPubMed
Schurch, M-A, Rizzoli, R, Slosman, D, Vadas, L, Vergnaud, P & Bonjour, J-P (1998) Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Int Med 128, 801–809.CrossRefGoogle ScholarPubMed
Shah, M, Miller, DS & Geissler, CA (1988) Lower metabolic rates of post-obese versus lean women: thermogenesis, basal metabolic rate and genetics. Eur J Clin Nutr 42, 741–752.Google ScholarPubMed
Sullivan, DH, Patch, GA, Walls, RC & Lipschitz, DA (1990) Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients. Am J Clin Nutr 51, 749–758.CrossRefGoogle Scholar
Thomas, B (2002) Manual of Dietetic Practice, 3rd ed, Oxford: Blackwell Scientific Publications.Google Scholar
Tkatch, L, Rapin, C-H, Rizzoli, R, Slosman, D, Nydegger, V, Vasey, H & Bonjour, J-P (1992) Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. J Am Coll Nutr 11, 519–525.CrossRefGoogle ScholarPubMed
Todorovic, V & Micklewright, A (editors) (2004) A Pocket Guide to Clinical Nutrition, 3rd ed. Birmingham PEN Group Publications.Google Scholar