Predicted REE estimates offer limited clinical utility in cirrhosis patients

Prediction equations appear to provide no useful estimates of resting energy expenditure (REE) in patients with cirrhosis, reports a study, adding that REE must be measured directly.

“REE, the major component of total energy expenditure, can be measured using indirect calorimetry (mREE) or estimated using prediction equations (pREE),” the investigators said.

In this study, 900 patients with cirrhosis (mean age 55.7 years, 70 percent men, 52 percent Southeast Asian) and 282 healthy controls (mean age 36.0 years, 52 percent men, 18 percent Southeast Asian) had available individual mREE data. Metabolic status was classified using thresholds based on the mean of the mREE in healthy controls.

The investigators then compared mREE and pREE estimates obtained using the Harris-Benedict, Mifflin, Schofield and Henry equations. They also created three new prediction models that included sex, ethnicity, body composition measures, and model for end-stage liver disease scores using Stepwise regression.

Patients with cirrhosis had significantly higher mean mREE than controls when referenced to dry body weight (22.4 cf. 20.8 kcal/kg/24 hr; p<0.001). No significant sex differences were observed between groups.

Moreover, the mean mREE was significantly higher among Caucasian patients relative to Asians (23.1 cf. 21.7 kcal/kg/24 hr; p<0.001). There were 37.1 percent of Caucasians and 25.3 percent of Asians who were classified as hypermetabolic.

Statistically and clinically relevant differences existed between mREE and pREE. The pREE estimates in the total patient population ranged from 501 to 548 kcal/24 hr more than the mREE. Newly derived prediction equations offered better estimates of mREE, but its clinical utility remained limited.

“Malnutrition is associated with adverse clinical outcomes in patients with cirrhosis,” the investigators said. “Accurate assessment of energy requirements is needed to optimize dietary intake.”