Association recognized obesity as a disease that requires medical treatment. Nutrition Examination survey 2009-2010, prevalence of obesity in the United States is 35.5% in adult men, 35.8% in adult women, including 4.4% and 8.2% respectively with BMI >40 kg/m2. * ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
A dietary prescription based on individual energy expenditure is the first step for obesity prevention and treatment. Resting energy expenditure contributes from 50-75% of total energy expenditure, depending on the physical activity level. Therefore, the assessment of REE provides useful information for weight management. * Agreement between Different Methods and Predictive Equations for REE Study aimed to evaluate the agreement between methods and equations for REE estimation for overweight and obese.
REE measured by indirect calorimetry, MSJ, WHO/FAO/UNU, Fleisch, Horie-Waitzberg and Gonzalez, and Ireton-Jones.
Found Mifflin, Horie-Waitzberg and Gonzalez, and Fleisch most appropriate to estimate needs. * Agreement between Different Methods and Predictive Equations for REE
Primary aim of study was to compare different methods for assessing energy expenditure in overweight and obese.
Assessed indirect calorimetry, respiratory quotient, and predictive equations: MSJ and Harris-Benedict.
Conclusion: Using indirect calorimetry or Harris- Benedict equation to assess REE in an older, overweight/obese population is more reliable and accurate than using RQ. Found MSJ estimate was less accurate than the Harris-Benedict when compared to IC. * Comparison of Energy Assessment Methods in Overweight Individuals Objective to analyze which REE predictive equation was the best alternative to IC.
27 predictive equations were assessed.
Found for US overweight and obese class I and II adults can best be predicted with the Mifflin equation, with almost 80% accuracy for US adults. * Validity of Predictive Equations for REE in US and Dutch Overweight and Obese Class I and II adults Recommendation: In the critically ill obese patient, if indirect calorimetry is unavailable, energy requirements should be based on the Penn State University 2010 predictive equation or the modified Penn State University equation if the patient is over the age of 60 years (strong). ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity Recommendation: In the hospitalized obese patient, if indirect calorimetry is unavailable and the Penn State University equation cannot be used, energy requirements may be based on the Mifflin- St Jeor equation using actual body weight (moderate). * ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
Rationale: Critically ill patients with BMI >45 kg/m2, accuracy of the PSU equation was highest at 76% compared to others studied. In older critically ill obese patient with BMI >30 kg/m2, a modified PSU appears to be more accurate than the original PSU, with accuracy of 70%. * ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
Where MSJ = Mifflin-St Jeor equation, VE = minute venitlation (L/minute), Tmax = maximum temperature in prior 24 hours in degrees C
* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
Recommendation: Clinical outcomes are at least equivalent in patients supported with high protein hypocaloric feeding to those supported with high protein eucaloric feeding. Suggested in patients who do not have severe renal or hepatic dysfunction.
Feedings started at 50-70% of estimated needs or <14 kcal/kg actual weight. High protein started with 1.2 g/kg actual weight or 2-2.5 g/kg IBW. * ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
Rationale: Insulin resistance, glucose intolerance, hyperlipidemia, nonalcoholic fatty liver disease, and hypoventilation syndrome are more prevalent in patients with obesity than non-obese. The hospitalized patient with obesity is susceptible to experiencing complications with overfeeding, hence why hypocaloric, high protein regimens have been designed by clinicians. * ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
Rationale: In the critically ill, ventilator- dependent obese patient, PSU equation most accurately predicts compared to others including: Harris-Benedict, Mifflin-St Jeor, Swinamer, and Ireton-Jones, with highest prediction accuracy of 70% and lowest likelihood of over or under estimation.
* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
1. Choban, P. , Dickerson, R., Malone, A., Worthington, P., Compher, C. A.S.P.E.N. Clinical Guidelines Nutrition Support of Hospitalized Adult Patients with Obesity. JPEN, 2014.
2. Esteves de Oliveria, F., Alves, R., Zuconi, C., Riberio, A. Agreement Between Different Methods and Predictive Equations for Resting Energy Expenditure in Overweight and Obese Brazilian Men. Journal of The Academy of Nutrition and Dietetics. September 2012. Volume 112, Number 9.
3. Anderson, E., Sylvia, L., Lynch, M., Sonnenberg, L., Lee, H., Nathan, D. Comparison of Energy Assessment Methods in Overweight Individuals. Journal of The Academy of Nutrition and Dietetics. February 2014. Volume 114, Number 2.
4. Weijs, P. Validity of Predictive Equations for REE in US and Dutch Overweight and Obese Class I and II Adults Aged 18-65 y. The American Journal of Clinical Nutrition. 2008, 88:959-70.