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Pitfalls in Predicting Resting Energy Requirements in Critically Ill Children: A Comparison of Predictive Methods to Indirect Calorimetry
Christine M. Hardy, MS, RD, CNSD*
Johanna Dwyer, DSc, RD
Linda K. Snelling, MD
Gerard E. Dallal, PhD
Joel W. Adelson, MD, PhD||
* Pediatric Gastroenterology and Nutrition and
Pediatric Critical Care, Rhode Island
Hospital, Providence, Rhode Island, Department
of Medicine and Division of Biostatistics, Tufts
University, Boston, Massachusetts, and || Division
of Gastroenterology, Children's Hospital Oakland, Oakland, California
Correspondence: Correspondence and reprint requests: Christine M. Hardy, MS, RD, CNSD,
Pediatric GI/Nutrition, MP-126, Rhode Island Hospital, 593 Eddy St.,
Providence, RI 02903. Electronic mail may be sent to
chardy{at}lifespan.org.
Background: Critical illness in children is thought to have
profound effects on nutritional status. It is essential to avoid complications
associated with inadequate nutrition support and delivery of excess energy.
Objective: To compare the results of several commonly used methods
for predicting energy requirements in a group of critically ill children
indirect calorimetry was used to measure energy expenditure in these children.
Design: Resting energy expenditures estimated by different prediction
methods for energy were compared with measurements of actual resting energy
expenditure obtained by indirect calorimetry in 52 children admitted to a
pediatric intensive care unit. Agreement between each predictive method and
indirect calorimetry was evaluated by Bland-Altman limits of agreement and by
whether the methods met the predetermined criterion for accuracy of within 10%
of the measured value. Results: None of the equations predicted
individual values accurately. Each of the predictive equations gave a wide and
variable scatter of predicted values around the median. The recommended
dietary allowance for energy was the least accurate and differed significantly
even from the other predictive methods, overestimating energy expenditure in
50 of 52 patients. None of the remaining methods stood out as being more
precise. Conclusions: Predictive methods commonly used to estimate
energy expenditure in critically ill children are very imprecise and may lead
to overprovision or underprovision of nutrition support. Resting energy
expenditure should be measured by indirect calorimetry whenever possible.
Nutrition in Clinical Practice, Vol. 17, No. 3,
182-189 (2002)
DOI: 10.1177/0115426502017003182
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