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Resting Energy Expenditure in the Parenterally Fed Pediatric Population With Crohn's Disease

Kathryn Cormier, RD, Diana Mager, RD, PhD, CSP^*,, Louise Bannister, RD, CNSD^*,, Marie Fortin, RD, MEd, Helen Richards, RN, MSc(N)^*, Cheryl Jackson, MSc (N), RN^* and Paul Pencharz, MB, ChB, PhD, FRCP^*,,

From the ^* Division of Gastroenterology/Nutrition, Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; and the Departments of Nutritional Sciences and Paediatrics, University of Toronto, Toronto, Ontario, Canada

Correspondence: Diana Mager, RD, PhD, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic mail may be sent to diana.mager{at}sickkids.ca.

Background: Malnutrition is a common sequela of Crohn's disease (CD) and may result in reduced skeletal muscle function and growth retardation. Energy requirements of parenterally fed hospitalized pediatric patients with active CD were measured using indirect calorimetry, to assess whether Food Agriculture Organization (FAO)/World Health Organization (WHO)/United Nations University (UNU) equations provide appropriate estimations of energy requirements in this patient population. Methods: Twenty hospitalized patients with active CD fed exclusively via parenteral nutrition (PN) were investigated. A chart review and patient interviews were conducted to assess disease duration, location, laboratory parameters, and symptomology associated with CD. Disease severity was quantified using the Pediatric Crohn's Disease Activity Index. Each subject underwent indirect calorimetry, bioelectrical impedance analysis, and anthropometric assessment once the ordered PN met estimated macronutrient requirements of each patient (predicted resting energy expenditure x 1.3). Predicted resting energy expenditure (REE) was determined using the FAO/WHO/UNU equations. Results: REE showed a strong correlation with predicted REE (r² = .73, p < .01). Conclusions: Measured REE did not significantly differ from predicted resting energy requirements. This indicates that REE for the parenterally fed pediatric patients with CD can be accurately predicted using the FAO/WHO/UNU equations.

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