DNS - please address activity AND stress factor use with REE equations. I had a hospital general floor case - a malnourished pt with pneumonia and a stage 2 wound. My student used MSJ with 1.2 activity, then 1.5 for stress. This provided a total of 40 calories/kg. My judgement was this will overfeed. She pointed out mild-moderate infection stress is 1.2-1.5. She used 1.5, even at 1.2, I felt this would be high.
Thanks for this video! A few questions... How often is adjusted body weight being used for these calculations? When would you suggest using it? Since Harris-Benedict was used for so long, has there been any evidence that the activity or stress factors we are used to adding need to be adjusted to prevent under or overfeeding since it is now known that we were using an equation that overestimated RMR to begin with? Thank you!
Thank you for your questions! This is how the Academy's Evidence Analysis Library (EAL) describes the usage of adjusted body weight: "Many of the resting metabolic rate, or RMR, equations that are used today by registered dietitian nutritionists are based on actual body weight. Research evaluating the use of adjusted body weight, or ABW, has been shown to underestimate or overestimate RMR depending on the patient's weight status. Reasoning behind using an ABW with individuals who weigh less than 95% or more than 115% of a standard body weight was based on the assumption that adipose tissue is inert; however, research to justify this assumption lacks evidence. If RMR cannot be measured by indirect calorimetry, actual body weight and the Mifflin-St. Jeor equation are recommended when estimating energy needs in non-critically ill patients. The Mifflin-St. Jeor equation demonstrated the most reliability in predicting resting energy expenditure, regardless of weight status, according to the Academy's Evidence Analysis Library Adult Weight Management Guideline. Alternative equations may need to be considered, as is the case with critical illness, mechanical ventilation, ascites, edema and other conditions. Although limited research exists, ABW and ideal body weight (IBW) have been used when assessing energy and protein needs in critically ill patients who have an elevated body mass index and require a hypocaloric and/or high-protein feeding. Estimations of IBW have also been used for people with amputations and spinal cord injuries. Dosing of prescription medications by pharmacists also may warrant use of an adjusted IBW; otherwise, in most other circumstances, RDNs will utilize actual body weight when assessing energy, protein and fluid needs." In regards to your question about the Harris-Benedict equation: From my literature searching, it seems fairly consistent that there are improvements needed for the Harris-Benedict equation to be more accurate for certain populations. While I did not find a consensus statement as to adjustments for activity or stress factors which were validated, I did see some interesting articles about some common populations and limitations using this equation for their needs predictions. If the RMR portion (unadjusted) of the equation were overestimating at baseline, there's potential that the entire equation may need revision as opposed to just overcorrecting the RMR overestimates with activity or stress factors. www.sciencedirect.com/science/article/pii/S0261561420306166 www.sciencedirect.com/science/article/abs/pii/S0271531707000383
Why no activity factor for ballpark method?
The last point of the video was so well stated! Thanks for another great video, guys!
It would be great if you can also make a video for energy needs calculations for the pediatric population (infants, children). Thanks.
Thanks for the great idea, we have that in our plans for future videos!
Thank you so much for the practical approach...Great video
Great video! Do you have information on the Academy's recommended activity factors for different situations?
DNS - please address activity AND stress factor use with REE equations. I had a hospital general floor case - a malnourished pt with pneumonia and a stage 2 wound. My student used MSJ with 1.2 activity, then 1.5 for stress. This provided a total of 40 calories/kg. My judgement was this will overfeed. She pointed out mild-moderate infection stress is 1.2-1.5. She used 1.5, even at 1.2, I felt this would be high.
Thanks for this video! A few questions...
How often is adjusted body weight being used for these calculations? When would you suggest using it?
Since Harris-Benedict was used for so long, has there been any evidence that the activity or stress factors we are used to adding need to be adjusted to prevent under or overfeeding since it is now known that we were using an equation that overestimated RMR to begin with?
Thank you!
Thank you for your questions!
This is how the Academy's Evidence Analysis Library (EAL) describes the usage of adjusted body weight:
"Many of the resting metabolic rate, or RMR, equations that are used today by registered dietitian nutritionists are based on actual body weight. Research evaluating the use of adjusted body weight, or ABW, has been shown to underestimate or overestimate RMR depending on the patient's weight status. Reasoning behind using an ABW with individuals who weigh less than 95% or more than 115% of a standard body weight was based on the assumption that adipose tissue is inert; however, research to justify this assumption lacks evidence. If RMR cannot be measured by indirect calorimetry, actual body weight and the Mifflin-St. Jeor equation are recommended when estimating energy needs in non-critically ill patients. The Mifflin-St. Jeor equation demonstrated the most reliability in predicting resting energy expenditure, regardless of weight status, according to the Academy's Evidence Analysis Library Adult Weight Management Guideline. Alternative equations may need to be considered, as is the case with critical illness, mechanical ventilation, ascites, edema and other conditions. Although limited research exists, ABW and ideal body weight (IBW) have been used when assessing energy and protein needs in critically ill patients who have an elevated body mass index and require a hypocaloric and/or high-protein feeding. Estimations of IBW have also been used for people with amputations and spinal cord injuries. Dosing of prescription medications by pharmacists also may warrant use of an adjusted IBW; otherwise, in most other circumstances, RDNs will utilize actual body weight when assessing energy, protein and fluid needs."
In regards to your question about the Harris-Benedict equation:
From my literature searching, it seems fairly consistent that there are improvements needed for the Harris-Benedict equation to be more accurate for certain populations. While I did not find a consensus statement as to adjustments for activity or stress factors which were validated, I did see some interesting articles about some common populations and limitations using this equation for their needs predictions. If the RMR portion (unadjusted) of the equation were overestimating at baseline, there's potential that the entire equation may need revision as opposed to just overcorrecting the RMR overestimates with activity or stress factors.
www.sciencedirect.com/science/article/pii/S0261561420306166
www.sciencedirect.com/science/article/abs/pii/S0271531707000383
Hello to all of you guys. Do you use MSJ x AF x IF for acutely ill px?
Yes we use MSJ equation
Very helpful. Now, I have to look at European recommendations to choose, as I work there.