RESUMO
Short bowel syndrome (SBS) represents a serious intestinal absorption disorder, and patients may be prone to severe malnutrition. Dietetic therapy is critically important both for immediate prognosis and successful long-term rehabilitation. To maintain energy balance, an accurate assessment of energy intake is required. Our objective was to compare energy intake (EI) assessed by 24-h dietary recalls (EIrecall), a standard clinical assessment, with the total energy expenditure measured by the doubly labelled water (TEEdlw) method in SBS patients and matched controls. A total of twenty-two participants (eleven each in the SBS and control groups (CG), six female and five male) were evaluated; CG were matched to SBS patients on the basis of age, BMI and sex. TEE was measured by DLW and compared with EI determined by four 24-h dietary recalls using the USDA Automated Multiple-Pass Method. Bland-Altman plots and paired Student's t test were used to compare EIrecall with TEEdlw (P<0·05). Participants' mean age was 53 (sd 8) years. TEEdlw (7·85 (SD 1·16) MJ/d, 0·14 (SD 0·02) MJ/kg per d) was significantly lower (P=0·014) compared with EIrecall (11·07 (SD 3·45) MJ/d, 0·21 (SD 0·08) MJ/kg per d) in the SBS group. On the other hand, in the CG group TEEdlw (10·02 (SD 1·86) MJ/d, 0·18 (SD 0·03) MJ/kg per d) was significantly higher (P=0·001) compared with EIrecall (7·19 (SD 1·68) MJ/d, 0·13 (SD 0·03) MJ/kg per d). In SBS patients, reported EI is higher than DLW-measured EI. Therefore, providing or prescribing energetic intake based on EIrecall without accounting for potential malabsorption-related losses can compromise the energy needs in SBS patients and affect nutritional status in the long term.
Assuntos
Registros de Dieta , Dieta , Ingestão de Energia , Avaliação Nutricional , Síndrome do Intestino Curto/fisiopatologia , Água , Idoso , Composição Corporal , Deutério , Metabolismo Energético , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isótopos de OxigênioRESUMO
Assessing energy requirements is a fundamental activity in clinical dietetic practice. The aim of this study was to investigate which resting energy expenditure (REE) predictive equations are the best alternatives to indirect calorimetry before and after an interdisciplinary therapy in Brazilian obese women. In all, twelve equations based on weight, height, sex, age, fat-free mass and fat mass were tested. REE was measured by indirect calorimetry. The interdisciplinary therapy consisted of nutritional, physical exercise, psychological and physiotherapy support during the course of 1 year. The average differences between measured and predicted REE, as well as the accuracy at the ±10 % level, were evaluated. Statistical analysis included paired t tests, intraclass correlation coefficients and Bland-Altman plots. Validation was based on forty obese women (BMI 30-39·9 kg/m2). Our major findings demonstrated a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid, obese women. The equations reported by Harris-Benedict and FAO/WHO/United Nations University (UNU) were the only ones that did not show significant differences compared with indirect calorimetry and presented a bias <5 %. The Harris-Benedict equation provided 40 and 47·5 % accurate predictions before and after therapy, respectively. The FAO equation provided 35 and 47·5 % accurate predictions. However, the Bland-Altman analysis did not show good agreement between these equations and indirect calorimetry. Therefore, the Harris-Benedict and FAO/WHO/UNU equations should be used with caution for obese women. The need to critically re-assess REE data and generate regional and more homogeneous REE databases for the target population is reinforced.