Andrea Carpenter1, Vicky Lee Ng2,3, Karen Chapman4, Simon C Ling2, Marialena Mouzaki2. 1. 1 Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada. 2. 2 Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 3. 3 SickKids Transplant Center, Toronto, Ontario, Canada. 4. 4 Clinical Research Unit, Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Malnutrition is common in children with end-stage liver disease (ESLD) and is associated with increased morbidity and mortality. The inability to accurately estimate energy needs of these patients may contribute to their poor nutrition status. In clinical practice, predictive equations are used to calculate resting energy expenditure (cREE). The objective of this study is to assess the accuracy of commonly used equations in pediatric patients with ESLD. METHODS: Retrospective study performed at the Hospital for Sick Children. Clinical, laboratory, and indirect calorimetry data from children listed for liver transplant between February 2013 and December 2014 were reviewed. Calorimetry results were compared with cREE estimated using the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield [weight], and Schofield [weight and height] equations. RESULTS: Forty-five patients were included in this study. The median age was 9 months, and the most common indication for transplantation was biliary atresia (64%). The Schofield [weight and height], FAO/WHO/UNU, and Schofield [weight] equations were compared with indirect calorimetry and found to have a mean (SD) difference of 48.8 (344.0), 59.3 (229.8), and 206.5 (502.6) kcal/d, respectively. The FAO/WHO/UNU, Schofield [weight], and Schofield [weight and height] equations introduced a mean error of 21%, 38%, and 76%, respectively. The FAO/WHO/UNU equation tended to underestimate, whereas the Schofield equations overestimated the REE. CONCLUSIONS: Commonly used predictive equations perform poorly in infants and young children with ESLD. Indirect calorimetry should be used when available to guide energy provision, particularly in children who are already malnourished.
BACKGROUND AND OBJECTIVES: Malnutrition is common in children with end-stage liver disease (ESLD) and is associated with increased morbidity and mortality. The inability to accurately estimate energy needs of these patients may contribute to their poor nutrition status. In clinical practice, predictive equations are used to calculate resting energy expenditure (cREE). The objective of this study is to assess the accuracy of commonly used equations in pediatric patients with ESLD. METHODS: Retrospective study performed at the Hospital for Sick Children. Clinical, laboratory, and indirect calorimetry data from children listed for liver transplant between February 2013 and December 2014 were reviewed. Calorimetry results were compared with cREE estimated using the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield [weight], and Schofield [weight and height] equations. RESULTS: Forty-five patients were included in this study. The median age was 9 months, and the most common indication for transplantation was biliary atresia (64%). The Schofield [weight and height], FAO/WHO/UNU, and Schofield [weight] equations were compared with indirect calorimetry and found to have a mean (SD) difference of 48.8 (344.0), 59.3 (229.8), and 206.5 (502.6) kcal/d, respectively. The FAO/WHO/UNU, Schofield [weight], and Schofield [weight and height] equations introduced a mean error of 21%, 38%, and 76%, respectively. The FAO/WHO/UNU equation tended to underestimate, whereas the Schofield equations overestimated the REE. CONCLUSIONS: Commonly used predictive equations perform poorly in infants and young children with ESLD. Indirect calorimetry should be used when available to guide energy provision, particularly in children who are already malnourished.
Authors: Estella M Alonso; Wen Ye; Kieran Hawthorne; Veena Venkat; Kathleen M Loomes; Cara L Mack; Paula M Hertel; Saul J Karpen; Nanda Kerkar; Jean P Molleston; Karen F Murray; Rene Romero; Philip Rosenthal; Kathleen B Schwarz; Benjamin L Shneider; Frederick J Suchy; Yumirle P Turmelle; Kasper S Wang; Averell H Sherker; Ronald J Sokol; Jorge A Bezerra; John C Magee Journal: J Pediatr Date: 2018-09-21 Impact factor: 4.406
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