Cc. Glynn et al., Predictive versus measured energy expenditure using limits-of-agreement analysis in hospitalized, obese patients, J PARENT EN, 23(3), 1999, pp. 147-154
Background: Accuracy of predictive formulae is crucial for therapeutic plan
ning because indirect calorimetry measurement is not always possible or cos
t effective. Energy requirements are more difficult to predict in the acute
ly ill obese patient compared with lean patients because of an increased re
sting energy expenditure per lean body mass and a variable stress response
to illness. Methods: A retrospective review of 726 patients identified 57 p
atients (32 spontaneous breathing, S; 25 ventilator dependent, V) with body
mass indexes of 30-50 kg/m(2). Limits-of-agreement analysis determined bia
s (the mean difference between measured and predicted values) and precision
(the standard deviation of the bias) to evaluate the accuracy of predictiv
e formulae compared with measured resting energy expenditure (MREE) by a De
ltatrac Metabolic Monitor. Predictive accuracy was determined within +/-10%
MREE. The predictive formulae examined were: variations of the Harris-Bene
dict equations using ideal, adjusted weights of 25% and 50% and actual weig
hts with stress factors ranging from 1.0 to 1.5; the Ireton-Jones equation
for obesity; the Ireton-Jones equations for hospitalized patients (S and V)
; and the ratio of 21 kcalories per kilogram actual weight. Results: The me
an MREE was 21 kcal/kg actual weight. The adjusted Harris-Benedict average
weight equation was optimal for predicting MREE for the combined S and V se
ts (bias = 182 +/- 123; 67% +/- 10% MREE), as well as the S subset (bias =
159 +/- 112; 69% +/- 10% MREE). Conclusions: The Harris-Benedict equations
using the average of actual and ideal weight and a stress factor of 1.3 mos
t accurately predicted MREE in acutely ill, obese patients with BMIs of 30-
50 kg/m(2). Predictive formulae were least accurate for obese, ventilator-d
ependent patients.