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Genomics and personalized strategies in nutrition

Do we need different predictive equations for the acute and late phases of critical illness? A prospective observational study with repeated indirect calorimetry measurements

European Journal of Clinical Nutrition volume 76, pages 527–534 (2022)Cite this article

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A Correction to this article was published on 25 October 2021

This article has been updated

Abstract

Background

Predictive equations (PEs) for estimating resting energy expenditure (REE) that have been developed from acute phase data may not be applicable in the late phase and vice versa. This study aimed to assess whether separate PEs are needed for acute and late phases of critical illness and to develop and validate PE(s) based on the results of this assessment.

Methods

Using indirect calorimetry, REE was measured at acute (≤5 days; n = 294) and late (≥6 days; n = 180) phases of intensive care unit admission. PEs were developed by multiple linear regression. A multi-fold cross-validation approach was used to validate the PEs. The best PEs were selected based on the highest coefficient of determination (R2), the lowest root mean square error (RMSE) and the lowest standard error of estimate (SEE). Two PEs developed from paired 168-patient data were compared with measured REE using mean absolute percentage difference.

Results

Mean absolute percentage difference between predicted and measured REE was <20%, which is not clinically significant. Thus, a single PE was developed and validated from data of the larger sample size measured in the acute phase. The best PE for REE (kcal/day) was 891.6(Height) + 9.0(Weight) + 39.7(Minute Ventilation)−5.6(Age) – 354, with R2 = 0.442, RMSE = 348.3, SEE = 325.6 and mean absolute percentage difference with measured REE was: 15.1 ± 14.2% [acute], 15.0 ± 13.1% [late].

Conclusions

Separate PEs for acute and late phases may not be necessary. Thus, we have developed and validated a PE from acute phase data and demonstrated that it can provide optimal estimates of REE for patients in both acute and late phases.

Trial registration

ClinicalTrials.gov NCT03319329.

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Data availability

The data sets generated and/or analysed during the current study are not publicly available due to the data confidentiality requirements of the ethics committee but are available from the corresponding author on reasonable request and approval from the ethics committee.

Change history

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Acknowledgements

Funding Support: Ministry of Education Malaysia, Fundamental Research Grant Scheme (FRGS) [grant number FRGS/1/2018/SKK02/UM/02/3 with project code FP003-2018A]; Educational grant from the Parenteral and Enteral Nutrition Society of Malaysia (PENSMA). We are grateful to the subjects and their families for their participation in this project. We wish to thank all the personnel from the Intensive Care Unit, University of Malaya Medical Centre, Department of Anaesthesiology, University of Malaya, and Department of Dietetics, University of Malaya Medical Centre for their contributions and support of this project.

Funding

The study was funded by the Ministry of Education Malaysia, Fundamental Research Grant Scheme (FRGS) [grant number FRGS/1/2018/SKK02/UM/02/3 with project code FP003-2018A] awarded to Associate Professor Dr M. Shahnaz Hasan. Ms Tah Pei Chien received educational grant from the Parenteral and Enteral Nutrition Society of Malaysia (PENSMA). All other co-authors have no financial disclosures. The sponsor of the study had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Pei Chien Tah, Zheng-Yii Lee & M. Shahnaz Hasan

  2. Department of Dietetics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia

    Pei Chien Tah

  3. Nutritional Sciences Programme & Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

    Bee Koon Poh

  4. Sector for Biostatistics & Data Repository, National Institutes of Health (NIH), Ministry of Health, Selangor, Malaysia

    Chee Cheong Kee

  5. Department of Anaesthesiology, KPJ Tawakkal Specialist Hospital, Kuala Lumpur, Malaysia

    Vineya-Rai Hakumat-Rai

  6. Department of Anaesthesiology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia

    Mohd Basri Mat Nor

  7. Centre of Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia

    Mazuin Kamarul Zaman

  8. Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Hazreen Abdul Majid

  9. Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia

    Hazreen Abdul Majid

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  1. Pei Chien Tah
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Contributions

PCT, BKP, CCK, ZYL, VRHR, MBMN, MKZ, HAM and MSH contributed to the conceptualization and design of the study; PCT recruited the patients and collected the data; PCT, CCK and ZYL contributed to the acquisition and analysis of data; PCT, BKP, CCK, ZYL, HAM and MSH contributed to the interpretation of data; PCT drafted the manuscript; PCT and MSH contributed to the funding acquisition. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to M. Shahnaz Hasan.

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The authors declare no competing interests.

Ethics approval and consent to participate

Ethics approval was granted by the Medical Research Ethics Committee (MREC), UMMC (MREC ID NO: 20161024-4407) and registered with the National Medical Research Register (NMRR) Malaysia (NMRR.ID: NMRR-16-2030-33143) and ClinicalTrials.gov (NCT03319329). Informed consent was obtained from the patients or their legal representative.

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Tah, P.C., Poh, B.K., Kee, C.C. et al. Do we need different predictive equations for the acute and late phases of critical illness? A prospective observational study with repeated indirect calorimetry measurements. Eur J Clin Nutr 76, 527–534 (2022). https://doi.org/10.1038/s41430-021-00999-y

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