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Measured Energy Expenditure of Tube-Fed Patients with Severe Neurodevelopmental Disabilities

Department of Clinical Pharmacy and Department of Pediatrics, University of Tennessee (J.E.W.), Memphis
Arlington Developmental Center, Arlington, Tennessee

Address reprint requests to: Roland N. Dickerson, PharmD, FACN, BCNSP, CNS, Department of Clinical Pharmacy, University of Tennessee, Memphis, 26 South Dunlap St., Memphis, TN 38163

Objective: To determine measured resting energy expenditure (REE) of nonambulatory tube-fed patients with severe neurological neurodevelopmental disabilities.

Methods: Twenty patients were prospectively studied. Only steady state indirect calorimetry measurements were taken. All measurements were conducted using a canopy system. Nutritional needs were met entirely by enteral feedings via a permanent ostomy.

Results: REE was widely distributed from 16 kcals/kg/day to 39 kcals/kg/day. The mean REE (888±176 kcals/day) of the patients was significantly (p<0.01) lower than predicted as estimated by the Harris-Benedict equations (1081±155 kcals/day) and World Health Organization equations (1194±167 kcals/day). Fat-free mass (FFM) was the best parameter for predicting REE. Two predictive equations were developed that are not significantly biased and more precise (15% error) than conventional predictive formulas.

Conclusion: Conventional formulas for estimating energy expenditure are inaccurate and generally overestimate measured energy expenditure of nonambulatory patients with severe developmental disabilities.

Key words: energy expenditure, enteral feeding, mental retardation, cerebral palsy, spasticity, quadriplegia, oxygen consumption

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