Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background

Patients with cirrhosis commonly present malnutrition, resulting in a significant imbalance in energy metabolism that negatively impacts their prognosis and quality of life. However, adequate dietary prescription depends on the precision of the protocols for energy requirement estimation, and the current literature is still conflicting regarding the relationship between cirrhosis progression and resting metabolic rate alterations.

Research motivation

Reliable calculation of resting energy expenditure (REE) in patients with cirrhosis is pivotal to appropriate therapeutic management. However, there is still a need to evaluate which of the predictive equations is more effective in the clinical setting.

Research objectives

The objective of the present study was to determine the REE of patients with cirrhosis by indirect calorimetry (IC) and compare the values thus obtained to those estimated by bioelectrical impedance analysis (BIA) and common predictive equations.

Research methods

This was an observational study performed at the Outpatient Gastroenterology and Liver Transplantation Clinics of Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brazil. Data from the electronic medical records of the patients, related to the diagnosis, staging by the Child-Pugh score, age, and sex of the participants, were collected. The diagnosis of cirrhosis was made by clinical, laboratory, imaging, and/or, eventually, liver biopsy in accordance with the hospital liver transplant group standards. BIA and IC were performed and the results were compared to energy expenditure predictive equations using the Bland-Altman method, and also the Student’s t-test for paired samples.

Research results

Ninety patients, with a mean age of 57.1 years, were assessed. The mean REE measured by IC was 1607.72 and there were no differences in REE when comparing groups with different Child-Pugh scores. The IC values were significantly different when compared to predictive methods, except for the McArdle and Food and Agriculture Organization of the United Nations, World Health Organization and United Nations University (FAO/WHO/UNU) predictive equations. The best agreement was found between IC and the IOM equation, followed by the FAO/WHO/UNU and McArdle equations. The agreement between IC and BIA was below 10% of the mean difference. The Harris and Benedict and the Mifflin equations showed less agreement with the IC values.

Research conclusions

The present study determined the REE of patients with cirrhosis, indicating that the McArdle and FAO/WHO/UNU equations showed the best agreement with IC, whilst the IOM and BIA could also be considered appropriate for REE estimation.

Research perspectives

Further studies in different populations of patients with cirrhosis, including different severity profiles, are needed to determine the best methods for REE estimation in clinical practice.