Energy expenditure and caloric balance after burn

Increased feeding leads to fat rather than lean mass accretion

David W. Hart, Steven Wolf, David Herndon, David L. Chinkes, Sophia O. Lal, Michael K. Obeng, Robert B. Beauford, Ronald P. Mlcak, Basil A. Pruitt, Douglas W. Wilmore, William G. Cioffi

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

Objective: Resting energy expenditure (REE) is commonly measured in critical illness to determine caloric "demands" and thus nutritive needs. Summary Background Data: The purpose of this study was to 1) determine whether REE is associated with clinical outcomes and 2) determine whether an optimal caloric delivery rate based on REE exists to offset erosion of lean mass after burn. Methods: From 1995 to 2001, REE was measured by indirect calorimetry in 250 survivors of 10 to 99%TBSA burns. Caloric intake and REE were correlated with muscle protein catabolism, length of stay, ventilator dependence, sepsis, and mortality. From 1998 to 2000, 42 patients (>60%TBSA burns) received continuous enteral nutrition at a spectrum of caloric balance between 1.0x REE kcal/d -1.8x REE kcal/d. Serial body composition was measured by dual energy x-ray absorptiometry. Lean mass, fat mass, morbidity, and mortality were determined. Results: REE/predicted basal metabolic rate correlated directly with burn size, sepsis, ventilator dependence, and muscle protein catabolism (P < .05). Declining REE correlated with mortality (P < .05). 2) Erosion of lean body mass was not attenuated by increased caloric balance, however, fat mass increased with caloric supply (P < .05). Conclusion: In surviving burned patients, caloric delivery beyond 1.2 × REE results in increased fat mass without changes in lean body mass. Declining energy expenditure appears to be a harbinger of mortality in severely burned patients.

Original languageEnglish (US)
Pages (from-to)152-161
Number of pages10
JournalAnnals of Surgery
Volume235
Issue number1
DOIs
StatePublished - 2002

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Energy Metabolism
Fats
Mortality
Muscle Proteins
Mechanical Ventilators
Burns
Sepsis
Basal Metabolism
Indirect Calorimetry
Enteral Nutrition
Body Composition
Energy Intake
Critical Illness
Survivors
Length of Stay
X-Rays
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Energy expenditure and caloric balance after burn : Increased feeding leads to fat rather than lean mass accretion. / Hart, David W.; Wolf, Steven; Herndon, David; Chinkes, David L.; Lal, Sophia O.; Obeng, Michael K.; Beauford, Robert B.; Mlcak, Ronald P.; Pruitt, Basil A.; Wilmore, Douglas W.; Cioffi, William G.

In: Annals of Surgery, Vol. 235, No. 1, 2002, p. 152-161.

Research output: Contribution to journalArticle

Hart, DW, Wolf, S, Herndon, D, Chinkes, DL, Lal, SO, Obeng, MK, Beauford, RB, Mlcak, RP, Pruitt, BA, Wilmore, DW & Cioffi, WG 2002, 'Energy expenditure and caloric balance after burn: Increased feeding leads to fat rather than lean mass accretion', Annals of Surgery, vol. 235, no. 1, pp. 152-161. https://doi.org/10.1097/00000658-200201000-00020
Hart, David W. ; Wolf, Steven ; Herndon, David ; Chinkes, David L. ; Lal, Sophia O. ; Obeng, Michael K. ; Beauford, Robert B. ; Mlcak, Ronald P. ; Pruitt, Basil A. ; Wilmore, Douglas W. ; Cioffi, William G. / Energy expenditure and caloric balance after burn : Increased feeding leads to fat rather than lean mass accretion. In: Annals of Surgery. 2002 ; Vol. 235, No. 1. pp. 152-161.
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T1 - Energy expenditure and caloric balance after burn

T2 - Increased feeding leads to fat rather than lean mass accretion

AU - Hart, David W.

AU - Wolf, Steven

AU - Herndon, David

AU - Chinkes, David L.

AU - Lal, Sophia O.

AU - Obeng, Michael K.

AU - Beauford, Robert B.

AU - Mlcak, Ronald P.

AU - Pruitt, Basil A.

AU - Wilmore, Douglas W.

AU - Cioffi, William G.

PY - 2002

Y1 - 2002

N2 - Objective: Resting energy expenditure (REE) is commonly measured in critical illness to determine caloric "demands" and thus nutritive needs. Summary Background Data: The purpose of this study was to 1) determine whether REE is associated with clinical outcomes and 2) determine whether an optimal caloric delivery rate based on REE exists to offset erosion of lean mass after burn. Methods: From 1995 to 2001, REE was measured by indirect calorimetry in 250 survivors of 10 to 99%TBSA burns. Caloric intake and REE were correlated with muscle protein catabolism, length of stay, ventilator dependence, sepsis, and mortality. From 1998 to 2000, 42 patients (>60%TBSA burns) received continuous enteral nutrition at a spectrum of caloric balance between 1.0x REE kcal/d -1.8x REE kcal/d. Serial body composition was measured by dual energy x-ray absorptiometry. Lean mass, fat mass, morbidity, and mortality were determined. Results: REE/predicted basal metabolic rate correlated directly with burn size, sepsis, ventilator dependence, and muscle protein catabolism (P < .05). Declining REE correlated with mortality (P < .05). 2) Erosion of lean body mass was not attenuated by increased caloric balance, however, fat mass increased with caloric supply (P < .05). Conclusion: In surviving burned patients, caloric delivery beyond 1.2 × REE results in increased fat mass without changes in lean body mass. Declining energy expenditure appears to be a harbinger of mortality in severely burned patients.

AB - Objective: Resting energy expenditure (REE) is commonly measured in critical illness to determine caloric "demands" and thus nutritive needs. Summary Background Data: The purpose of this study was to 1) determine whether REE is associated with clinical outcomes and 2) determine whether an optimal caloric delivery rate based on REE exists to offset erosion of lean mass after burn. Methods: From 1995 to 2001, REE was measured by indirect calorimetry in 250 survivors of 10 to 99%TBSA burns. Caloric intake and REE were correlated with muscle protein catabolism, length of stay, ventilator dependence, sepsis, and mortality. From 1998 to 2000, 42 patients (>60%TBSA burns) received continuous enteral nutrition at a spectrum of caloric balance between 1.0x REE kcal/d -1.8x REE kcal/d. Serial body composition was measured by dual energy x-ray absorptiometry. Lean mass, fat mass, morbidity, and mortality were determined. Results: REE/predicted basal metabolic rate correlated directly with burn size, sepsis, ventilator dependence, and muscle protein catabolism (P < .05). Declining REE correlated with mortality (P < .05). 2) Erosion of lean body mass was not attenuated by increased caloric balance, however, fat mass increased with caloric supply (P < .05). Conclusion: In surviving burned patients, caloric delivery beyond 1.2 × REE results in increased fat mass without changes in lean body mass. Declining energy expenditure appears to be a harbinger of mortality in severely burned patients.

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