Original Articles
Resting energy expenditure and prediction equations in young children with failure to thrive,☆☆

https://doi.org/10.1067/mpd.2000.103852Get rights and content

Abstract

Objective: To compare predicted and measured resting energy expenditure (REE) in young children (birth to 3 years) with failure to thrive (FTT). Methods: REE (kcal/d) was measured by indirect calorimetry and compared with predicted REE from 3 sex and age group equations: World Health Organization (WHO), Schofield weight-based (SCH-WT), and Schofield weight- and height-based (SCH-WT-HT). The clinical characteristics associated with inaccuracy of predicted REE were examined. Results: Forty-five subjects (47% female) were evaluated. Their clinical characteristics (mean ± SD) included age 1.2 ± 0.7 years, length/height z score –2.1 ± 1.3, weight z score –2.7 ± 1.0, and measured REE 438 ± 111 kcal/d. All prediction equations were within 10% accuracy <50% of the time. However, SCH-WT-HT did not significantly differ from measured REE (450 ± 138 vs 438 ± 111 kcal/d, P =.2) and was least likely to underestimate REE. Younger age and more severe growth failure (based on weight, length/height, or both) were associated with underestimation of REE by prediction equations. Conclusion: REE should be measured in young infants and children with moderate to severe FTT when knowledge of caloric needs is required for optimal clinical care. The SCH-WT-HT equation was least likely to underestimate REE and is therefore preferred when REE cannot be measured in this group of children. (J Pediatr 2000;136:345-50)

Section snippets

METHODS

Subjects aged birth to 3 years with a clinical diagnosis of FTT who were referred between 1993 and 1997 for REE measurement as part of clinical management were considered for enrollment into the study. Once referred, a standard protocol including growth assessment, measurement of REE, and body composition was followed. Weight was measured with a digital electronic stand-on scale or infant scale (Scale-Tronix Inc, Wheaton, IL) to 0.1 and 0.01 kg, respectively. Recumbent length was measured to

RESULTS

Forty-five subjects were enrolled (47% female)(Table I).All subjects had a clinical diagnosis of FTT, and only 11% had no other secondary clinical diagnosis; 64% of the subjects had more than 2 secondary diagnoses in addition to the FTT. Gastrointestinal disorders including gastroesophageal reflux, malabsorption, and allergic enteropathy formed most (61%) of the secondary clinical diagnoses. Other clinical diagnoses included neurologic (18%), cardiac (7%), and pulmonary disorders (4%). No

DISCUSSION

In this sample of young children with moderate to severe FTT, all prediction equations were within 10% less than half the time. However, SCH-WT-HT compared best with measured REE and underestimated REE less frequently. Being younger (for WHO and SCH-WT), having more severe growth failure (based on WAZ, HAZ, or both), or both were associated with underestimation of energy requirements by prediction equations. The infants and children in this study had poor growth compared with the reference

References (18)

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    The analysis also was conducted using the World Health Organization/Food and Agriculture Organization and Schofield weight equations, and the results were similar (data not shown). Our results with 4 times the sample size confirm previous findings that the MREE and PREE do not agree in chronically ill children.3,4,10,11 In our cohort, REE was underpredicted and the SD of the %MREE/SCHOHW was approximately 3 times that of the healthy population.5,10

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    The modified Weir equation was used to calculate energy equivalencies.26 Expected REE was determined by means of the Schofield weight-height equation,27 based on age, weight, and height, a method unlikely to underestimate REE in children with growth failure.28 Patients' daily estimated energy requirements (EER) were calculated by means of formulas that incorporate age, weight, and height and include factors for activity and growth.29

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Supported in part by the Nutrition Center at The Children’s Hospital of Philadelphia.

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Reprint requests: Timothy A. Sentongo, MD, Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104.

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