Wednesday, August 4, 2010

Predictive Energy Equations: Which One to Use?


Dietetic interns challenge us to keep our practice current. The question of what predictive energy equation to use in clinical practice was a recent example of how our roles as educators linked to our need to keep current. Fraser Health (FH) interns recognized their preceptors had different approaches to calculating estimated energy needs for their patients and wondered how something so core to dietitians’ daily activities could be so varied in practice. A poll of Canadian dietitians and a literature review provided perspectives on the use of predictive energy equations.

Indirect calorimetry (IC) is the ‘gold standard’ for calculating energy requirements. Several barriers prevent routine measurements on patients including lack of a metabolic cart or personnel to operate equipment, and the impracticality of completing repeated measures on every patient who requires an energy calculation. Consequently, dietitians rely on predictive energy equations to estimate patients’ energy needs.

Over 200 predictive energy equations have been published in efforts to accurately predict energy needs (MacDonald and Hildebrandt, 2003; Ireton- Jones, 2005). No equation has consistently proven to be accurate in hospitalized individuals in acute or critical care. Inaccuracies are introduced due to controversy over which weight to use, the limited number of validation studies done, and the homogeneity of reference populations used when establishing the formulae, amongst other variables (Frankenfield et al., 2005; Fabiono et al., 2009; Walker and Heuberger, 2009).

An e-mail poll in October 2009 to members of the Dietitians of Canada (DC) Clinical Nutrition Managers’ Network yielded a list of the equations used by at least one dietitian at each of the 16 responding sites: 13 sites used Harris Benedict (HB); eight used the American College of Chest Physicians’ equation (25kcal/kg); six used Mifflin-St Jeor; five used one of the Ireton-Jones’ equations; and two used one of the Penn State equations. These results were consistent with practices worldwide (HB remains the most frequently-used formula (Fabiono et al., 2009)), and the varied practices that the FH dietetic interns had noticed.

The e-mail poll also yielded information on which weight (actual, ideal, or adjusted) is used in energy calculations. Four sites used actual weight only and 12 sites used either actual or adjusted weight depending on the individual case. Most sites adjusted body weight using a 25% factor (based on a 1984 American Dietetic Association publication as referenced in Krenitsky, 2005). Other sources recommended a 50% factor (Barack et al., 2002; Krenitsky, 2005). The use of adjusted body weight is not well supported (Barack et al., 2002; Ireton-Jones, 2005; Krenitsky, 2005).

The following points summarize the support for the predictive energy equations with graded evidence-for-use in clinical practice:

Harris-Benedict (Harris and Benedict, 1919): Not sufficiently accurate to be used in the critically ill (Grade I evidence) (Frankenfield et al., 2007) Use actual body weight (Walker and Heuberger, 2004; Krenitsky, 2005).

American College of Chest Physicians (Cerra et al., 1997): Use 25-30 kcal/kg actual body weight for the nonobese critically ill (Grade IV and V evidence). Use 11-14 kcal/kg actual body weight or 22-25 kcal/kg ideal body weight for the obese critically ill (Grade III evidence) (McClave et al., 2009).

Mifflin-St Jeor (Mifflin et al., 1990): Best predictor of energy needs in healthy nonobese and obese adults (Frankenfield et al., 2005). Use actual body weight (McClave et al., 2009). Not recommended in the critically ill (Grade V evidence) (Frankenfield et al., 2007).

Ireton Jones et al. (1992): Most accurate in young and obese adults compared to other populations. Insufficient data to reject the equation (Grade III evidence supporting its use) (Frankenfield et al., 2007; Walker and Heuberger, 2009)

Penn State 1998 and 2003 (Frankenfield et al., 2004): May use 1998 equation for obese, critically ill ventilated patients (Frankenfield et al., 2005). May use 2003 equation for nonobese critically ill patients (Walker and Heuberger, 2009) (Grade III evidence) (Frankenfield, et al., 2007; Walker and Heuberger, 2009).

Swinamer (Swinamer et al., 1987): May use for nonobese critically ill patients (Grade III evidence) (Frankenfield, et al, 2007; Walker and Heuberger, 2009).

Even with an accurate predictive equation, obtaining goal intakes is often hindered by delays in establishing feeding access, enteral feed intolerances, and feedings that are held for tests. Our efforts should go toward achieving goal tubefeeding rates and maximizing oral intake regardless of what equation is used. Further, monitoring markers of feeding adequacy including laboratory measures, weight, ventilator weaning, and wound healing allow us to adjust energy goals as appropriate.

Based on the results of our survey and literature review, we can have confidence in reporting to our interns that there is more to learn before setting standards for estimating energy needs in hospital inpatients. We use these teaching moments as opportunities to discuss the concept of evidence-based practice using best available research, clinical expertise, and a patient-focused approach to guide decision-making to provide the best possible patient care.

A summary chart of the origins and evidence on predictive energy equations is available on request.




Contact

Tamar Kafka, RD, MSc
Dietetic Internship Coordinator/Research Dietitian
Fraser Health
New Westminster BC
E: Tamar.Kafka@fraserhealth.ca





1,034 comments:

«Oldest   ‹Older   1001 – 1034 of 1034
KeiraDoltan said...

Complete Your Assignment From
MBA Assignment Help

custom packaging boxes said...

custom packaging boxes provide customer satisfaction with a given priority to the needs of the customers.Our unique designs and high-quality printing techniques guarantee high performance and smart boxes for the customers.The company offers wholsale eyelash packaging box and custom printed makeup packaging boxes. So, one who is willing to buy cosmetic boxes at a wholesale rate, custom packaging boxes-UK would never hesitate to assist that customer. We use offset presses and digital art for the latest techniques of printing cosmetic boxes for our clients.

Education In London said...

MBA
MBA in London
Business School in London
Business School

Education In London said...

MBA
MBA in London
Business School in London
Business School

Education In London said...

MBA
MBA in London
Business School in London
Business School

Davidpunk160 said...

www.mcafee.com/activate is the perfect site to redeem your activation code and activate your McAfee antivirus. McAfee is a leading antivirus solution that safeguards your data from cyberattacks and internet viruses. From web security to system tuning, McAfee is a reliable program that has everything you’d expect from a premium cutting-edge antivirus software. Returning users can visit mcafee.com/activate to download the software on your system. Users who’d wish to opt for a new account can follow the user guide below to download, install, and activate McAfee antivirus.
Mcafee.com/activate
Mcafee.com/activate
Mcafee.com/activate
Mcafee.com/activate
Mcafee.com/activate

Mobile Giant said...

Oppo Reno 5 and Oppo Reno 5 Pro | Oppo Reno 5 Review | Full Specification | Mobile Giant

Packers And Movers Bangalore said...

I do consider all the ideas you have presented on your post. They're really convincing and will certainly work. @ Packers And Movers Bangalore

Roman Davis said...

Answer questions are very important for learning because most of the students like to get knowledge by asking something from the teachers that is why we have to arrange a question sheet for them to check their general knowledge and their interest. Essay writing service

Robin Hicks said...

Very nice article and easy to understand. What is 5G: All You Need to Know? 5G can enable immediate connectivity to billions of devices connected via the Internet of Things (IoT). The Fifth Generation network has the potential to provide speed, enable low latency and connectivity to allow a new generation of applications, services, and business opportunities.

Priyanka Sharma said...

Hey, Thank you so much for sharing this informational post. I would love to read more posts like this one.
Migraine Treatment in Ayurveda

Anonymous said...

I’m just saying your website is AWSOME! Thank you so much! Please visit also my website.
Click here!!

Safari said...

great post
how do i completely remove avast

Unknown said...


افضل شركة تنظيف ستوفر لك يد العون كلما احتجت الى تنظيف منزلك نعلم انا جميع الاشخاص مشغولون في الغالب بالعمل الاطفال لراعيتهم فلماذا لاتاخذ قسطا من الراحه وتترك تلك الاعمال لنا ؟سواء كان لديك منزل كبير شقه صغيره اوحتى مكتب عمل ستوفر لك شركة خده التنظيف المناسبه شامله التطهير ونفض الغبار وكل مايتعلق بالنظافه المنزليه على اتم الاستعداد لتولي نظافة منزلك لمرة واحده اواعلى اوقات منظمه تحددها انت سعيدين بمساعدتك في جميع الاوقات ونتظرين اتصالك الان
افضل شركت نقل عفش بتبوكة

شركت تنظيف منازل بتبوك

افضل شركة تنظيف بتبوك

شركة رش موبيدات بتبوك

شركة تنظيف سجاد وموكيت بتبوكة


mohamed nader said...


افضل شركة تنظيف ستوفر لك يد العون كلما احتجت الى تنظيف منزلك نعلم انا جميع الاشخاص مشغولون في الغالب بالعمل الاطفال لراعيتهم فلماذا لاتاخذ قسطا من الراحه وتترك تلك الاعمال لنا ؟سواء كان لديك منزل كبير شقه صغيره اوحتى مكتب عمل ستوفر لك شركة خده التنظيف المناسبه شامله التطهير ونفض الغبار وكل مايتعلق بالنظافه المنزليه على اتم الاستعداد لتولي نظافة منزلك لمرة واحده اواعلى اوقات منظمه تحددها انت سعيدين بمساعدتك في جميع الاوقات ونتظرين اتصالك الان
افضل شركت نقل عفش بتبوكة

شركت تنظيف منازل بتبوك

افضل شركة تنظيف بتبوك

شركة رش موبيدات بتبوك

شركة تنظيف سجاد وموكيت بتبوكة

mohamed nader said...


افضل شركة تنظيف ستوفر لك يد العون كلما احتجت الى تنظيف منزلك نعلم انا جميع الاشخاص مشغولون في الغالب بالعمل الاطفال لراعيتهم فلماذا لاتاخذ قسطا من الراحه وتترك تلك الاعمال لنا ؟سواء كان لديك منزل كبير شقه صغيره اوحتى مكتب عمل ستوفر لك شركة خده التنظيف المناسبه شامله التطهير ونفض الغبار وكل مايتعلق بالنظافه المنزليه على اتم الاستعداد لتولي نظافة منزلك لمرة واحده اواعلى اوقات منظمه تحددها انت سعيدين بمساعدتك في جميع الاوقات ونتظرين اتصالك الان
افضل شركت نقل عفش بتبوكة

شركت تنظيف منازل بتبوك

افضل شركة تنظيف بتبوك

شركة رش موبيدات بتبوك

شركة تنظيف سجاد وموكيت بتبوكة

domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting domain and hosting said...

thanks for sharing amazing blo.

call center software said...

Thank you for this post. Good luck.
Call Center Software

Spotify Premium Apk Free Download said...

jungleboyzz

Unknown said...

Kunjungi website kami untuk informasi pengeluaran nomor toto4d Sydney paling lengkap dan terakurat. Website akan diupdate setiap harinya sesuai dengan jadwal Sydneypools.
Website : Pengeluaran Sidney

Heartbreak Clinic said...



Recover after a breakup actually very tough this is the best article for helping recover
Heartbreak Clinic

web design company scotland said...

Awesome write-up. Apart from business, blogging came into exist as a part of passion

Digital Marketing Scotland

web design company in glasgow

seo company in glasgow

web design company in glasgow

rajendrakumar said...

good Cinema Box application works on all iphone devices with most current iOS variations. Cinema Box iOS HD App Download for iPhone & iPad it will ask you to login with your apple id
chloros

NHS Negligence Claim said...

Amazing info. Thanks for sharing.
Suing the NHS
NHS Negligence Claims

Rahul said...

The Usefulness of Butterfly Valve in Industries Today
The Introduction of Ball Valve
Ball Valve History & Mystery
Things To Consider Before Making Your Purchase
Pressure Reducing Valves

DMAI said...

Nutrition may affect clinical outcomes in critically ill patients, and providing either more or fewer calories than the patient needs can adversely affect outcomes.

Thanks & Regards
BhaveshK
Best Digital Marketing Agency in Surat
Best Rapier Loom Machine Manufacturer in Surat
Best Electronic Jacquard Machine Manufacturer in Surat
Best High-Speed Loom Jacquard Machine Manufacturer in Surat
Best High-Speed Rapier Looms Machine Manufacturer in Surat
Best Velvet Loom Machine Manufacturer in Surat
Best Velvet Fabric Shearing Machine Manufacturer in Surat
Best Velvet Fabric Slitting Machine Manufacturer in Surat
Best Rapier Dobby Loom Machine Manufacturer in Surat
Best Textile Machine Manufacturer in Surat

Mobile Giant said...

What an informative & impressive post . Keep it up !!!!How to do Keyword Research

Anonymous said...

Thanks for such an amazing article. Keep Posting.
Please Visit Gyapu Online Shopping Nepal for the best deals in Nepal.

Anonymous said...

Effective SEO Services in New York and help to get traffic, leads, and sales. Digital World Giant offers the best SEO services in New York by SEO professionals to every ideal customer.best seo services new york

National News said...

Usually, I never comment on blogs but your article is so convincing that I never stop myself to say something about it. You’re doing a great job Man, Keep it up.

Visit Leo News - this site also provide most trending and latest articles

Sahib Khan said...

contact us for free
visit here
click there
website
click here

visit now
online
blog
dhook
source

Sahib Khan said...

click here
visit now
click this link here
source
click there
visit
random
indexing
page link
source page

Sport11 — Fantasy Gaming App said...

Sport11 - Play Online Daily Fantasy Cricket Game in India.
Sport11 is the best fantasy cricket game in India, play online fantasy cricket games and win an unlimited cash prize, download App and get instant Rs. 100 cash bonus.
Play Fantasy Cricket App

Assignment Help said...

Complete Your Assignment From
help with assignment

«Oldest ‹Older   1001 – 1034 of 1034   Newer› Newest»