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Energy balance in critical illness

Published online by Cambridge University Press:  08 December 2008

Lindsay D. Plank  and
Graham L. Hill
Lindsay D. Plank*
Affiliation:
Department of Surgery, University of Auckland, Auckland, New Zealand
Graham L. Hill
Affiliation:
Department of Surgery, University of Auckland, Auckland, New Zealand
*
*Corresponding author: Dr Lindsay D.Plank, fax +64 9 377 9656, email l.plank@auckland.ac.nz
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Abstract

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Energy balance is the difference between energy consumed and total energy expended. Over a given period of time it expresses how much the body stores of fat, carbohydrate and protein will change. For the critically-ill patient, who characteristically exhibits raised energy expenditure and proteolysis of skeletal muscle, energy balance information is valuable because underfeeding or overfeeding may compromise recovery. However, there are formidable difficulties in measuring energy balance in these patients. While energy intake can be accurately recorded in the intensive care setting, the measurement of total energy expenditure is problematic. Widely used approaches, such as direct calorimetry or doubly-labelled water, are not applicable to the critically ill patient. Energy balance was determined over periods of 5–10 d in patients in intensive care by measuring changes in the fat, protein and carbohydrate stores of the body. Changes in total body fat were positively correlated with energy balance over the 5 d study periods in patients with severe sepsis (n24, r 0.56, P=0.004) or major trauma (n 24, r 0.70, P<.0001). Fat oxidation occurred in patients whose energy intake was insufficient to achieve energy balance. Changes in body protein were independent of energy balance. These results are consistent with those of other researchers who have estimated total energy requirements from measurements of O2 consumption and CO2 production. In critically-ill patients achievement of positive non-protein energy balance or total energy balance does not prevent negative N balance. Nutritional therapy for these patients may in the future focus on glycaemic control with insulin and specialised supplements rather than on energy balance per se.

Keywords

Critical illnessEnergy balanceNutritional support
Type
Clinical Nutrition and Metabolism Group Symposium on ‘Control of energy balance in health and disease’
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 2 , May 2003 , pp. 545 - 552
Copyright
Copyright © The Nutrition Society 2003

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