Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

Estimating energy requirements in hospitalised underweight and obese patients requiring nutritional support: a survey of dietetic practice in the United Kingdom

European Journal of Clinical Nutrition volume 66, pages 394–398 (2012)Cite this article

Abstract

BACKGROUND:

Many methods are available to determine energy requirements, however, all have limitations, particularly when used for the obese.

OBJECTIVES:

The aim of this survey was to investigate current practice in the estimation of energy requirements in an underweight and obese hospitalised patient in a large cohort of UK dietitians.

SUBJECT/METHODS:

A cross-sectional anonymous online survey of UK registered dietitians was performed.

RESULTS:

A total of 672 responses were received. Underweight patient: prediction equations with adjustment for metabolic stress and physical activity were most commonly used (90%). The median estimated energy requirement was 2079 kcals/day. The estimated energy requirement using calorie per kilogram method was significantly lower compared with equations (P<0.001). The median target volume of feed prescribed was 2000 mls/day. A significant reduction in feed prescribed compared with estimated energy requirements was found (P<0.001). Obese patient: prediction equations to estimate the basal metabolic rate alone were most commonly used (51%). Nutrition support dietitians used a lower stress factor compared with non-nutrition support dietitians (P=0.016). Method used to estimate the energy requirements was associated with years in clinical practice and place of work (P<0.001, 0.001). Calorie per kilogram used in the obese case study (median: 25 kcal/kg) was significantly lower than calorie per kilogram used in the underweight case study (median: 30 kcal/kg; P=0.014).

CONCLUSIONS:

A significant variation in the methods used by dietitians to estimate the energy requirements was found, particularly in the obese patient group. In an age of rapidly increasing rates of obesity a professional consensus of treatment of this patient group is needed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. McWhirter J, Pennington C . Incidence and recognition of malnutrition in hospital. BMJ 1994; 308, 945.

    Article  CAS  Google Scholar 

  2. Breen H, Ireton-Jones C . Predicting energy needs in obese patients. Nutr Clin Pract 2004; 19, 284–289.

    Article  Google Scholar 

  3. Savard J, Faisy C, Lerolle N, Guerot E, Diehl J, Fagon J . Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients. Criti Care Med 2008; 36, 1175–1183.

    Article  Google Scholar 

  4. Roza A, Shizgal H . The Harris-Benedict equation reevaluated - resting energy requirements and the body cell mass. Am J Clin Nutr 1984; 40, 168–182.

    Article  CAS  Google Scholar 

  5. Frankenfield D, Roth-Yousey L, Compher C . Comparison of predictive equations for resting metabolic rate in healthy non-obese and obese adults: a systematic review. J Am Diet Assoc 2005; 105, 775–789.

    Article  Google Scholar 

  6. Boullata J, Williams J, Cottrell F, Hudson L, Compher C . Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc 2007; 107, 393–401.

    Article  Google Scholar 

  7. Reeves MCS . Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice. Eur J Clin Nutr 2003; 57, 1530–1535.

    Article  CAS  Google Scholar 

  8. Wells J, Williams J, Haroun D, Fewtrell M, Colantuoni A, Siervo M . Aggregate predictions improve accuracy when calculating metabolic variables used to guide treatment. Am J Clin Nutr 2009; 89, 491–499.

    Article  CAS  Google Scholar 

  9. Anderegg B, Worrall C, Barbour E, Simpson K, DeLegge M . Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. J Parenter Enteral Nut 2009; 33, 168–175.

    Article  Google Scholar 

  10. Glynn C, Greene G, Winkler M, Albina J . Predictive versus measured energy expenditure using limits-of-agreement analysis in hospitalized, obese patients. J Parenterl Enteral Nut 1999; 23, 147–154.

    Article  CAS  Google Scholar 

  11. Alves V, da Rocha E, Gonzalez M, da Fonseca R, Silva M, Chiesa C . Assessment of resting energy expenditure of obese patients: comparison of indirect calorimetry with formulae. Clin Nutr 2009; 28, 299–304.

    Article  Google Scholar 

  12. Harris J . A Biometric Study of Basal Metabolism in Man. Carnegie Institute: Washington, 1919.

    Google Scholar 

  13. Schofield W . Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 1985; 39 (Suppl 1), 5–41.

    Google Scholar 

  14. Weekes E . Controversies in the determination of energy requirements. Proc Nutr Soc 2007; 66, 367–377.

    Article  Google Scholar 

  15. Reeves M, Capra S . Predicting energy requirements in the clinical setting: are current methods evidence based? Nutr Rev 2003; 61, 143–151.

    Article  Google Scholar 

  16. Scalfi L, Coltorti A, Sapio C, Dibiase G, Borrelli R, Contaldo F . Predicted and measured resting energy expenditure in healthy young women. Clin Nutr 1993; 12, 1–7.

    Article  CAS  Google Scholar 

  17. Frankenfield D, Rowe W, Smith J, Cooney R . Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc 2003; 103, 1152–1159.

    Article  Google Scholar 

  18. Weijs J, Kruizenga A, Van Dijk A, van der Meij BS, Langius JA, Knol DL et al. Validation of predictive equations for resting energy expenditure in adult outpatients and inpatients. Clin Nutr 2008; 27, 150–157.

    Article  Google Scholar 

  19. NCCAC. Nutrition Support for Adults; Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. NCCAC: London, 2006.

  20. Todorovic V, Micklewright A . A Pocket Guide to Clinical Nutrition. PENG & BDA: Birmingham, 2004.

    Google Scholar 

  21. Hamwi GJ . Therapy: changing dietary concepts. In: Danowski TS (ed). Diabetes Mellitus: Diagnosis and Treatment, vol. 1. American Diabetes Association: New York, 1964, pp 73–78.

    Google Scholar 

  22. Piers L, Diffey B, Soares M, Frandsen SL, McCormack LM, Lutschini MJ et al. The validity of predicting the basal metabolic rate of young Australian men and women. Eur J Clin Nutr 1997; 51, 333–337.

    Article  CAS  Google Scholar 

  23. Mifflin M, Stjeor S, Hill L, Scott B, Daugherty S, Koh Y . A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr 1990; 51, 241–247.

    Article  CAS  Google Scholar 

  24. Krenitsky J . Adjusted body weight: evidence to support the use of adjusted body weight in calculating calorie requirements. Nutr Clin Pract 2005; 20, 468–473.

    Article  Google Scholar 

  25. Ahmad A, Duerksen D, Munroe S, Bistrian B . An evaluation of resting energy expenditure in hospitalized, severely underweight patients. Nutrition 1999; 15, 384–388.

    Article  CAS  Google Scholar 

  26. Bergin N, Kinder C, Holdoway A . Elucidating reasons for failure to administer prescribed volume of nasogastric enteral feeds in a district general hospital. Proc Nutr Soc 2009; 68, E31.

    Article  Google Scholar 

  27. Green A, Smith P, Whelan K . Estimating resting energy expenditure in patients requiring nutritional support: a survey of dietetic practice. Eur J Clin Nutr 2008; 62, 150–153.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was funded by the King's College London.

Author information

Authors and Affiliations

  1. Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK

    D Judges, A Knight, E Graham & L M Goff

Authors
  1. D Judges
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Knight
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E Graham
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L M Goff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L M Goff.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Contributors: DJ was involved in the data analysis and interpretation, drafting and revising of the manuscript for final submission. AK was involved in the conception and study design, data analysis and interpretation, drafting and revising of manuscript for final submission. EG was involved in the conception and study design, data collection and analysis. LG was involved in the conception and study design, data analysis and interpretation, drafting and revising of manuscript for final submission.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Judges, D., Knight, A., Graham, E. et al. Estimating energy requirements in hospitalised underweight and obese patients requiring nutritional support: a survey of dietetic practice in the United Kingdom. Eur J Clin Nutr 66, 394–398 (2012). https://doi.org/10.1038/ejcn.2011.211

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2011.211

Keywords

This article is cited by

Search

Advanced search

Quick links