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Abstract

A variety of formulae are used by clinicians to estimate calorie requirements in hospitalized obese patients. Many of these formulae have been validated by determining their correlation to calorie requirements as determined by indirect calorimetry (IC). The use of correlation coefficients (CC) in this manner may be misleading. A more appropriate statistical method, limits of agreement (LA), for comparing clinical measurements has recently been described by Bland and Altman. We obtained a total of 188 IC measurements on 113 obese (>120% IBW), mechanically ventilated patients. These were compared by CC and LA to seven formulaic methods of determining calorie requirements. All formulae correlate significantly with IC. Analysis by LA indicated acceptable bias in several formulae (eg, 21 kcal/kg, Ireton-Jones obese patients (IJ), Ireton-Jones ventilatory patients, (VEE); however, the uniform lack of precision demonstrated by all formulae renders their clinical utility questionable.

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References

Tighe AP , Allison DB , Kral JG , et al. Nutritional Support of Obese Patients. In: Rombeau and Caldwell, eds. Clinical nutrition-parenteral nutrition, 2nd ed. Philadelphia, PA: WB Saunders Co, 1993;716-36.

Ravussin E. , Bogardus C. Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization. Am J Clin Nutr 1989;49 (Suppl 5):968-75.

Ireton-Jones CS , Turner WW

Actual or ideal body weight: which should be used to predict energy expenditure?

J Am Diet Assoc 1991;91:193-5.

Jeevanandam M. , Young DH , Schiller WR Obesity and the metabolic response to severe multiple trauma in man. J Clin Invest 1991 ;87:262-9.

Ottenbarcher KJ , Stull GA The analysis and interpretation of method comparison studies in rehabilitation research. Am J Phys Med Rehabil 1993;72:266-71.

Ottenbacher KJ , Tomchek SD Measurement variation in method comparison studies: an empirical examination. Arch Phys Med Rehabil 1994;75:505-12.

Bland JM , Altman DG Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-10.

Harris JA , Benedict PG Biometric studies of basal metabolism in man. Washington, DC: Carnegie Institute of Washington, 1919; 1-266. (Publication No. 270)

Ireton-Jones CS , Borman KR , Turner WW Nutrition considerations in the management of ventilator-dependent patients. NCP 1993 ;8:60-4.

10.

Owen OE , Kavle E. , Owen RS , et al. A reappraisal of caloric requirements in healthy women. Am J Clin Nutr 1986;44:1-19.

11.

Owen OE , Holup JL , D'Alessio DA , et al. A reappraisal of the caloric requirements of men. Am J Clin Nutr 1987;46:875-85.

12.

Dickerson RN , Rosato EF , Mullen JL Net protein anabolism with hypocaloric parenteral nutrition in obese stressed patients. Am J Clin Nutr 1986;44:747-55.

13.

Baxter JK , Bistrian BR Moderate hypocaloric parenteral nutrition in the critically ill, obese patient . NCP 1989;4:133-5.

14.

Burge JC , Goon A. , Choban PS , et al. Efficacy of hypocaloric total parenteral nutrition in hospitalized obese patients: a prospective, double-blind randomized trial. JPEN 1994;18:203-7.

15.

Edens NK , Gil KM , Elwyn DH The effects of varying energy and nitrogen intake on nitrogen balance, body composition, and metabolic rate. Clin Chest Med 1986;7:3-17.

16.

Feurer ID , Crosby LO , Buzby GP , et al. Resting energy expenditure in morbid obesity. Ann Surg 1983;197:17-21.

Formulaic Methods of Estimating Calorie Requirements in Mechanically Ventilated Obese Patients: A Reappraisal

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