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
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.
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.
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.
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.
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.
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.
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.