Ferreira S, Marroni CA, Stein JT, Rayn R, Henz AC, Schmidt NP, Carteri RB, Fernandes SA. Assessment of resting energy expenditure in patients with cirrhosis. World J Hepatol 2022; 14(4): 802-811 [PMID: 35646265 DOI: 10.4254/wjh.v14.i4.802]
Corresponding Author of This Article
Sabrina Alves Fernandes, PhD, Postdoc, Research Scientist, Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rua Professor Duplan, 72 apto 01, Porto Alegre 90420-030, Brazil. sabrinaafernandes@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2022; 14(4): 802-811 Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.802
Assessment of resting energy expenditure in patients with cirrhosis
Shaiane Ferreira, Cláudio Augusto Marroni, Jessica Taina Stein, Roberta Rayn, Ana Cristhina Henz, Natália P Schmidt, Randhall B Carteri, Sabrina Alves Fernandes
Shaiane Ferreira, Cláudio Augusto Marroni, Jessica Taina Stein, Roberta Rayn, Ana Cristhina Henz, Natália P Schmidt, Sabrina Alves Fernandes, Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
Randhall B Carteri, Department of Nutrition, Centro Universitário Metodista - IPA, Porto Alegre 90420-060, Brazil
Randhall B Carteri, Department of Health and Behavior, Catholic University of Pelotas, Pelotas 96015-560, Brazil
Author contributions: Ferreira S contributed to the conception and design of the study, data collection, statistical analysis and writing of the manuscript; Marroni CA contributed to the conception and design of the study and writing of the manuscript; Stein JT, Henz AC and Rayn RG collected the data; Schmidt NP contributed to the conception and design of the study, data collection; Carteri RB statistical analysis and manuscript writing; Fernandes SA manuscript writing and critical review.
Institutional review board statement: This study was approved by the Research Ethics Committee of Irmandade Santa Casa de Misericórdia de Porto Alegre (No. 2.387.800).
Informed consent statement: Patients who agreed to participate in the study signed the Free and Informed Consent Form.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest related to this article.
Data sharing statement: No additional data is available for sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sabrina Alves Fernandes, PhD, Postdoc, Research Scientist, Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rua Professor Duplan, 72 apto 01, Porto Alegre 90420-030, Brazil. sabrinaafernandes@gmail.com
Received: December 1, 2021 Peer-review started: December 1, 2021 First decision: January 12, 2022 Revised: January 13, 2022 Accepted: March 26, 2022 Article in press: March 26, 2022 Published online: April 27, 2022 Processing time: 142 Days and 9.6 Hours
Abstract
BACKGROUND
Malnutrition affects 20% to 50% of patients with cirrhosis. It may be associated with serious complications and has a direct impact on prognosis. Resting energy expenditure (REE) is an important parameter to guide the optimization of therapy and recovery of nutritional status in patients with cirrhosis. However, the REE of patients with cirrhosis is still unclear, casting doubt upon the optimal nutritional management approach.
AIM
To identify the best method that predicts the REE of cirrhotic patients, using indirect calorimetry (IC) as the gold standard.
METHODS
An observational study was performed on 90 patients with cirrhosis. REE was assessed by IC, bioelectrical impedance analysis (BIA), and predictive formulas, which were compared using Bland-Altman plots and the Student’s t-test.
RESULTS
REE values measured by IC (1607.72 ± 257.4 kcal) differed significantly from those determined by all other methods (BIA: 1790.48 ± 352.1 kcal; Harris & Benedict equation: 2373.54 ± 254.9 kcal; IOM equation: 1648.95 ± 185.6 kcal; Cunningham equation: 1764.29 ± 246.2 kcal), except the Food and Agriculture Organization of the United Nations, World Health Organization, and United Nations University (FAO/WHO/UNU) (1616.07 ± 214.6 kcal) and McArdle (1611.30 ± 241.8 kcal) equations. We found no significant association when comparing IC and 24-h dietary recall among different Child-Pugh classes of cirrhosis.
CONCLUSION
The IOM and FAO/WHO/UNU equations have the best agreement with the CI. These results indicate a possibility of different tools for the clinical practice on cirrhotic patients.
Core Tip: Patients with cirrhosis usually have a poor nutritional status, associated with complications of liver disease, which is an independent factor for mortality. Identifying the metabolic energy expenditure of these patients is the main guide for a more assertive nutritional and clinical application. The objective of this study was to recognize the best method for estimating resting energy expenditure between bioelectrical impedance analysis and predictive formulas, compared to the gold standard, indirect calorimetry (IC). Ninety cirrhotic patients were included. The Food and Agriculture Organization of the United Nations, World Health Organization and United Nations University (FAO/WHO/UNU) equation showed the best agreement with the IC. These results indicate a possibility of different tools for the clinical practice on cirrhotic patients.
