Article | Published:

Comparison of estimated energy requirements using predictive equations with total energy expenditure measured by the doubly labelled water method in acute spinal cord injury

Spinal Cord (2019) | Download Citation

Abstract

Study design

Prospective, observational

Objectives

To evaluate agreement between a reference method (doubly labelled water, DLW) of total energy expenditure (TEE) and published equations for estimating energy requirements in acute spinal cord injury (SCI).

Setting

Victoria, Australia

Methods

Twenty participants (18 male) within 8 weeks of traumatic SCI completed DLW, anthropometric and dietary intake assessments. Energy requirements were predicted using Harris-Benedict, Schofield, Henry, Nelson, Buchholz and Chun equations, multiplied by a combined activity and stress factor of 1.3, and the ratio method (kJ/kg body weight). Fat-free mass (FFM) and fat mass (FM) were calculated from TBW-derived DLW and from bioelectrical impedance spectroscopy (BIS).

Results

Median time since injury was 41 days. Median TEE was 9.1 MJ. Fair agreement was found between TEE and predicted energy requirements for the Chun (rc = 0.39), the Harris-Benedict equation (rc = 0.30), the ratio method (rc = 0.23) and the Buchholz (rc = 0.31) and Nelson equations (rc = 0.35), which incorporate measures of FFM and/or FM. Other equations showed weak concordance with DLW. When two hypermetabolic patients were removed, agreement between TEE and predicted energy requirements using the Buchholz equation increased to substantial (rc = 0.72) and using the Nelson (rc = 0.53) and Chun equations (rc = 0.53) increased to moderate. The Buchholz equation had the smallest limits of agreement (−2.4–2.3 MJ/d).

Conclusion

The population-specific Buchholz equation that incorporates FFM, predicted from either BIS or DLW, demonstrated the best agreement in patients with acute SCI.

Sponsorship

The study was funded by grants from the Institute for Safety, Compensation and Recovery Research (ISCRR Project # NGE-E-13-078) and Austin Medical Research Foundation. M Panisset was supported by an Australian Postgraduate Award.

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Acknowledgements

The authors would like to acknowledge the contributions of the participants and their families, the spinal liaison officers and the dietetics department for their support and to thank Professor Peter Davies from the University of Queensland for the isotope analysis.

Funding

The study was funded by grants from the Institute for Safety, Compensation and Recovery Research (ISCRR Project # NGE-E-13-078) and Austin Medical Research Foundation. M Panisset was supported by an Australian Postgraduate Award.

Authors contributions

KJD participated in study design, contributed to grant procurement, performed data collection, performed data entry, drafted the manuscript. MGP participated in study design, contributed to grant procurement, performed data collection, performed data entry, contributed to statistical analyses, contributed to manuscript preparation. JR participated in study design, contributed to grant procurement, performed data collection, performed data entry, contributed to manuscript preparation. HR participated in study design, contributed to grant procurement, performed data collection, performed data entry, contributed to manuscript preparation. LCW advised on data collection protocol, performed data quality assurance, contributed to statistical analyses and manuscript preparation. AN provided medical oversight, commented on the manuscript. MPG developed the concept for and designed the study, contributed to grant procurement and manuscript preparation

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Author information

Affiliations

  1. Department of Nutrition and Dietetics, Austin Health, Heidelberg, VIC, 3084, Australia

    • Katherine J. Desneves
    • , Jillian Rafferty
    •  & Helena Rodi
  2. Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3010, Australia

    • Maya G. Panisset
    •  & Mary P. Galea
  3. School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, 4072, Australia

    • Leigh C. Ward
  4. Victorian Spinal Cord Service, Austin Health, Heidelberg, VIC, 3084, Australia

    • Andrew Nunn
    •  & Mary P. Galea

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Conflict of interest

Author Ward consults to Impedimed Ltd. The remaining authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for this study was obtained from the Austin Health Human Research Ethics Committee (H2013/05117) and all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed.

Corresponding author

Correspondence to Katherine J. Desneves.

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DOI

https://doi.org/10.1038/s41393-019-0253-9