Resting Energy Expenditure and Its Relationship With Patterns of Obesity and Visceral Fat Area in Chinese Adults

Objective To investigate the relationship between resting energy expenditure (REE) and patterns of obesity/regional fat parameters in Chinese adults. Methods Body mass index (BMI), fat mass (FM), fat-free mass (FFM) were assessed in 109 Chinese adults (52 men and 57 women), and their abdominal visceral adipose tissue area (VA) and subcutaneous fat area (SA) were measured using magnetic resonance imaging (MRI) measurements. REE was measured with indirect calorimetry and compared with normal and obese subjects. Multivariate analysis was used to study the factors related to REE. Results The resting energy expenditure per kilogram of body weight (REE/kg) was closely related with the area of abdominal visceral fat measured with MRI. REE/kg was significantly lower in overweight/obesity subjects than in normal-weighted subjects, and significantly lower in subjects with abdominal obesity (VA≥100 cm2) than in subjects with non-abdominal obesity (VA< 100 cm2, BMI≥25 kg/m2). In the stepwise regression analysis of REE/kg on regional fat parameters, VA in men and women and SA in women were independent factors reversely related to REE/kg. Conclusion REE/kg is associated with the visceral fat area and more prominent in men. REE/kg can be used as an index in the pathophysiology of intra-abdominal obesity.

Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma

BACKGROUND The diagnosis of malnutrition in patients with independent hepatocellular carcinoma(HCC)varies from 20%to 50%,is related to important complications and has a direct impact on the prognosis.Determination of the resting energy expenditure(REE)has become an important parameter in this population,as it allows therapeutic adjustments to recover their nutritional status.The REE in cirrhosis,with and without HCC,is not clearly defined,and requires the identification and definition of the best nutritional approach.AIM To evaluate the REE of patients with cirrhosis,with and without HCC.METHODS This is a prospective observational study evaluating the REE of 118 patients,33 with cirrhosis and hepatocellular carcinoma and a control group of 85 patients with cirrhosis without HCC,using indirect calorimetry(IC),bioimpedance,and predictive formulas.RESULTS The REE determined by IC in cirrhotic patients with HCC was 1643±364 and in those without HCC was 1526±277(P=0.064).The REE value as assessed by bioimpedance was 1529±501 for those with HCC and 1660±385 for those without HCC(P=0.136).When comparing the values of REE determined by IC and predictive formulas in cirrhotics with HCC,it was observed that only the formulas of the Food and Agriculture Organization(FAO)/World Health Organization(WHO)(1985)and Cunningham(1980)presented values similar to those determined by IC.When comparing the REE values determined by IC and predictive formulas in cirrhotics without HCC,it was observed that the formulas of Schofield(1985),FAO/WHO(1985),WHO(2000),Institute of Medicine(IOM)(2005)and Katch and McArdie(1996)presented values similar to those determined by IC.CONCLUSION The FAO/WHO formula(1985)could be used for cirrhotic patients with or without HCC;as it is the one with the values closest to those obtained by IC in these cirrhotic patients.

Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

AIM: To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy. METHODS: Within 24 h of intensive care unit management, patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L. Resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilogram (REE/kg), and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system. The changes in body composition were analyzed by multi-frequency bioimpedance analysis. Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance. RESULTS: Sixty patients were enrolled. Compared with preoperative baseline, postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05, respectively) on postoperative days 1 and 3 in the IIT group. Meanwhile the concentration of total protein, albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05, respectively). Compared with the CIT group, IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg, P = 0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg, P = 0.013); and decreased the Ln-HOMA-IR score (P = 0.019, 0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P = 0.017, 0.006); the total protein and albumin concentrations in the IIT group were greater than those in the CIT group (P = 0.023, 0.009). Postoperative values of internal cell fluid (ICF), fat mass, protein mass (PM), muscle mass, free fat mass and body weight decreased obviously on postoperative 7th day compared with the preoperative baseline in the CIT group (P < 0.05, respectively). IIT reduced markedly consumption of fat mass, PM and ICF compared with CIT (P = 0.009 to 0.026). CONCLUSION: There were some benefits of IIT in decreasing the perioperative insulin resistance state, reducing energy expenditure and consumption of proteins and lipids tissue in patients undergoing gastrectomy.

Assessment of physical stress during the perioperative period of endoscopic submucosal dissection

The advantage of endoscopic submucosal dissection(ESD)is that it is less invasive than surgery.ESD is one of the best treatments for older patients as surgery in this age group of patients is difficult.However,it is unclear how much lower the physical stress of ESD is compared with that of surgery.Thus,objective methods are required to assess physical stress in patients who have undergone ESD.The current review of ESD aimed to summarize the recent advancements in the assessment of physical stress during the perioperative period,focusing on changes in energy metabolism and serum opsonic activity(SOA).Based on metabolic changes,resting energy expenditure(REE)was measured using an indirect calorimeter.The stress factor calculated from the REE and the basal energy expenditure computed using the Harris-Benedict equation can be used to assess physical stress.SOA was assessed using the chemiluminescence method,wherein the use of chemiluminescent probes(i.e.,lucigenin and luminol)allowed quantification of reactive oxygen species generated by neutrophils.Using an auto luminescence analyzer,the results were evaluated based on the maximum light emission and area under the emission curve.These quantifiable results revealed the minimal invasiveness of ESD.

Metabolic and nutritional aspects in continuous renal replacement therapy

Nutrition is one of the foundations for supporting and treating critically ill patients.Nutritional support providescalories,protein,electrolytes,vitamins,and trace elements via the enteral or parenteral route.Acute kidneyinjury(AKI)is a common and devastating problem in critically ill patients and has significant metabolic andnutritional consequences.Moreover,renal replacement therapy(RRT),whatever the modality used,also profoundly impacts metabolism.RRT and of the extracorporeal circuit impede‘effect the evaluation of a patient’senergy requirements by clinicians.Substrates added and removed within the extracorporeal treatment are notalways taken into consideration,making treatment even more challenging.Furthermore,evidence on nutritionalsupport during continuous renal replacement therapy(CRRT)is scarce,and there are no clinical guidelines fornutrition adaptations during CRRT in critically ill patients.Most recommendations are based on expert opinions.This review discusses the complex interaction between nutritional support and CRRT and presents somemilestones for nutritional support in critically ill patients on CRRT.