Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.802
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
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.
To identify the best method that predicts the REE of cirrhotic patients, using indirect calorimetry (IC) as the gold standard.
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.
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.
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.