Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis
Edward J Kasarskis, Marta S Mendiondo, Dwight E Matthews, Hiroshi Mitsumoto, Rup Tandan, Zachary Simmons, Mark B Bromberg, Richard J Kryscio, ALS Nutrition/NIPPV Study Group, Edward J Kasarskis, Richard J Kryscio, Marta S Mendiondo, Stephen Wells, Christie Shrestha, Margaret Healey, Megan Thompson, Lan Chi T Luu, Carmen Saylor, Kathryn Vanderpool, Irina Kasarskis, Maria Malguizo, Renato Moreira, Stephen Welch, Hiroshi Mitsumoto, Jackie Montes, Daniel Bell, Wahida Karmally, Megan Tubman, Kate Dalton, Jonathan Hupf, Zachary Simmons, Helen Stephens, Ally Brothers, Susan Deiling, Michelle Heckenluber, Mark B Bromberg, Summer Davis, Rup Tandan, Chris Potter, Dwight Matthews, Shannon Lenox, Jesse Gardner, Stephen N Scelsa, Theresa Imperato, Yvonne D Rollins, Hans Neville, Bjorn Oskarsson, Burleen Hewitt, John Cumming, Terry D Heiman, Roseanne Sattazahn, Michael Sherman, Sara Feldman, Melonie Mitchell, Henry Ford, Daniel S Newman, Helen Foley, Ashok Verma, Julie Steele, Donald A Koggan, Jeremy M Shefner, Mary Lou Watson, Carlayne Jackson, Pamela Kittrell, Robert L Sufit, Laurie Gutmann, Peng Huang, Noah Lechtzin, Robin A Conwit, Janice Cordell, Edward J Kasarskis, Marta S Mendiondo, Dwight E Matthews, Hiroshi Mitsumoto, Rup Tandan, Zachary Simmons, Mark B Bromberg, Richard J Kryscio, ALS Nutrition/NIPPV Study Group, Edward J Kasarskis, Richard J Kryscio, Marta S Mendiondo, Stephen Wells, Christie Shrestha, Margaret Healey, Megan Thompson, Lan Chi T Luu, Carmen Saylor, Kathryn Vanderpool, Irina Kasarskis, Maria Malguizo, Renato Moreira, Stephen Welch, Hiroshi Mitsumoto, Jackie Montes, Daniel Bell, Wahida Karmally, Megan Tubman, Kate Dalton, Jonathan Hupf, Zachary Simmons, Helen Stephens, Ally Brothers, Susan Deiling, Michelle Heckenluber, Mark B Bromberg, Summer Davis, Rup Tandan, Chris Potter, Dwight Matthews, Shannon Lenox, Jesse Gardner, Stephen N Scelsa, Theresa Imperato, Yvonne D Rollins, Hans Neville, Bjorn Oskarsson, Burleen Hewitt, John Cumming, Terry D Heiman, Roseanne Sattazahn, Michael Sherman, Sara Feldman, Melonie Mitchell, Henry Ford, Daniel S Newman, Helen Foley, Ashok Verma, Julie Steele, Donald A Koggan, Jeremy M Shefner, Mary Lou Watson, Carlayne Jackson, Pamela Kittrell, Robert L Sufit, Laurie Gutmann, Peng Huang, Noah Lechtzin, Robin A Conwit, Janice Cordell
Abstract
Background: Patients with amyotrophic lateral sclerosis (ALS) experience progressive limb weakness, muscle atrophy, and dysphagia, making them vulnerable to insufficient energy intake. Methods to estimate energy requirements have not been devised for this patient group.
Objective: The goal was to develop equations to estimate energy requirements of ALS patients.
Design: We enrolled 80 ALS participants at varying stages of their illness and studied them every 16 wk over 48 wk. At each time, we determined total daily energy expenditure (TDEE) in the home setting over a 10-d period by using the doubly labeled water method. We then developed statistical models to estimate TDEE by using factors easily obtained during a routine clinical visit.
Results: The most practical TDEE models used the Harris-Benedict, Mifflin-St Jeor, or Owen equations to estimate resting metabolic rate (RMR) and 6 questions from the revised ALS Functional Rating Scale (ALSFRS-R) that relate to physical activity. We developed a Web-based calculator to facilitate its use. In the research setting, measuring body composition with bioelectrical impedance spectroscopy enabled the estimation of RMR with the Rosenbaum equation and the same 6 questions from the ALSFRS-R to estimate TDEE. By using these models, the estimate of TDEE for nutritional maintenance was ±500 kcal/d across the spectrum of ALS progression.
Conclusions: Our results emphasize the importance of physical function and body composition in estimating TDEE. Our predictive equations can serve as a basis for recommending placement of a feeding gastrostomy in ALS patients who fail to meet their energy requirements by oral intake.
Trial registration: ClinicalTrials.gov NCT00116558.
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Source: PubMed