Basal Energy Expenditure of Chinese Healthy Adults:Comparison of Measured and Predicted Values

Objective This study aimed to measure the basal energy expenditure(BEE)of Chinese healthy adults and establish an accurate predictive equation for this population.Methods In total,470 Chinese healthy adults had their BEE measured using the Cosmed K4b2 portable metabolic system.Multiple linear regression analysis was applied to develop new optimal equations for predicting BEE.The bias,accuracy rate,concordance correlation coefficient(CCC),and root mean square error(RMSE)were used to evaluate the accuracy of the predictive equations.Results There was a significant difference in BEE between males and females,with 5,954 kJ/d and 5,089 kJ/d,respectively.People living in rural areas expended significantly higher BEE(5,885 kJ/d)than those in urban areas(5,279 kJ/d).Previous equations developed by Henry,Schofield,Harris-Benedict(HB),and Liu overestimated the BEE of Chinese healthy adults.The new equations derived from the present study displayed the smallest average bias and RMSE from the measured basal energy expenditure(mBEE).The CCC of the new equations was higher than other predictive equations,but it was lower than 0.8.There was no significant difference in the accuracy rate among all predictive equations.Conclusions Sex and regional differences in BEE were observed in Chinese healthy adults.Neither the widely used previous predictive equations nor the one derived in the present study were accurate enough for estimating the BEE of Chinese healthy adults.Further study is required to develop more accurate equations for predicting the BEE of Chinese healthy adults aged between 20–45 years.

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.

Assessment of metabolic flexibility by measuring maximal fat oxidation during submaximal intensity exercise:Can we improve the analytical procedures?

Assessment of maximal fat oxidation rate(MFO)during a submaximal exercise test has been employed by many studies to investigate the differences in metabolic flexibility(MetFlex)across several populations.Nevertheless,many incorrect assumptions and methodological limitations exist in the procedures employed by previous studies,which might lead to misinterpretation of the reported findings.Considering the data retrieved from 19 trained men(Age:[27±4]years;%Body fat:[16.4±4.5]%;maximal oxygen consumption:[55.8±5.3]mL·kg^(−1)·min^(−1))who performed a graded exercise test over a motor-driven treadmill,this opinion paper shows that MFO alone does not perfectly capture the MetFlex in response to submaximal intensity exercise and recommend a novel index that considers both fat oxidation and energy expenditure modifications for an accurate examination of MetFlex.

When is parenteral nutrition indicated?

The indications and contraindications of parenteral nutrition(PN)are discussed in view of recent clinical find-ings.For decades,PN has been restricted to patients unable to tolerate enteral nutrition(EN)intake owing to the perceived risk of severe side-effects.The evolution of the PN substrate composition and delivery of nutrition via all-in-one bags has dramatically improved the application prospects of PN.Recent studies show similar compli-cation rates of nutrition therapy administered through enteral and intravenous routes.Therefore,indications of PN have,based on evidence,extended beyond complete gastrointestinal(GI)failure to include conditions such as insufficient EN generating persistent negative energy balance and insufficient protein intakes,malabsorption,or specific needs that are impossible to cover with EN feeds.

Nutritional and metabolic management of COVID-19 intensive care patients

Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19(COVID-19)patients.The aim of this review is to describe these disturbances during the progression of the disease,from the pre-intubation phase through the ventilated condition to the post extubation phase.The analysis of new data describing the prevalence of malnutrition,the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent patients from experiencing severe energy deficit and muscle loss.Rehabilitation may be extremely prolonged and therefore,nutrition is mandatory to decrease this recondition pe-riod.This review also comments on the European Society of Parenteral and Enteral Nutrition(ESPEN)nutritional statements.