Alberda, C

Belland, D

Den Heyer, V

Eslamparast, T

Ferreira, LG

Gramlich, L

Henry, CJ

Jackson, CD

Kalaitzakis, E

Knudsen, AW

Limon-Miro, AT

Madden, AM

Morgan, MY

Plank, LD

Prieto De Frias, C

Raman, M

Tandon, P

Yamanaka-Okumura, H

English

UCL Discovery

293 VALIDITY OF CURRENT RECOMMENDED DAILY ENERGY INTAKES IN PEOPLE WITH CIRRHOSIS BASED ON INDIVIDUAL PATIENT DATA Ana Teresa Limon-Miro1, Clive D. Jackson2, TannazEslamparast1, Hisami Yamanaka-Okumura3, Lindsay D.Plank4, Christiani Jeyakumar Henry5, Angela M. Madden6,Livia Garcia Ferreira7, Evangelos Kalaitzakis8,9, CésarPrieto De Frías10, Anne Wilkens Knudsen11, Leah Gramlich1,Maitreyi Raman12, Cathy Alberda13, Dawn Belland14, VanessaDen Heyer14, Marsha Y Morgan15 and Puneeta Tandon1, (1)Department of Medicine, University of Alberta, (2)Department of Neurophysiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, (3)Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, (4)Department of Surgery, University of Auckland, (5)Department of Biochemistry, University of Singapore, (6)School of Life and Medical Sciences, University of Hertfordshire, (7)Surgery Postgraduate Program, Medical School, Universidade Federal De Minas Gerais, (8)Gastro Unit, Division of Endoscopy, Copenhagen University Hospital, (9)Department of Gastroenterology, University Hospital of Heraklion, University of Crete, (10)Department of Gastroenterology, Clínica Universidad De Navarra, (11)Medical Division and Medical Unit, Nutritional Division, Copenhagen University Hospital Hvidovre, (12)Deparment of Medicine, Division of Gastroenterology, University of Calgary, (13)Royal Alexandra Hospital, Alberta Health Services, (14)University of Alberta Hospital, Alberta Health Services Nutrition Services, (15) Division of Medicine, UCL Institute for Liver and Digestive Health, Department of Medicine, Royal Free Campus,University College London Background: A number of National and International organisations have made recommendations in relation to daily energy intakes in patients with cirrhosis (Table). The advice across guidelines is discordant. Energy intake should balance total energy expenditure (TEE) but accurate TEE data are not available in this patient population so TEE is extrapolated from measured resting energy expenditure (mREE) using the formula TEE=1.3*mREE (ESPEN guideline recommendation). This study aims to assess the effects of (i) providing daily energy intakes as per the available guideline, based on TEE=1.3*mREE; (ii) varying the estimates for TEE based on multiples of mREE. Methods: Indirect calorimetry was used to measure REE in 900 patients with cirrhosis (mean [±1SD] age 55.7±11.6 yr; 70% men; 52% Asian descent). Daily energy intakes were calculated for individual patients according to each of the available guidelines viz ESPEN 1997,2006, and 2019; ISHEN 2013 and EASL 2019. The proportions of patients who, based on the individual recommended guidelines, met, exceeded or failed to meet their estimated daily energy requirements, based on a TEE of 1.3*mREE, were determined. The effect of varying the estimates for TEE on the accuracy of the estimated daily energy requirements was explored using multiples of 1.1-1.5*mREE and the ESPEN 1997 recommended daily energy intake of 25-35kcal/ kg. Results: If the ESPEN 1997 recommended intakes were applied then 66% of patients would meet their estimated daily energy requirements. However, if the intakes recommended in the other guideline were applied then high proportion of the patients would exceed their estimated daily energy needs viz ESPEN 2006, 88%; ESPEN 2019, 64%; EASL 2019, 88% (BMI £30) and 79% (BMI >30); and ISHEN 2013, 82% (BMI <20), 90% (BMI 20-30) and 37% (BMI >30-40). Increasing the estimates for TEE based on mREE significantly increased the proportions of patients meeting their estimated daily energy requirements. Thus, using an estimated TEE of mREE*1.35 the provision of 25-35 kcal/kg dry body weight would adequately meet the daily requirements of 70.4% of patients with cirrhosis and exceed requirements in only 14%. Conclusion: If the guidelines for daily energy intakes are based on the currently recommended estimate for TEE then intakes would be overestimated for the majority of patients with cirrhosis. Guidelines need to be based on accurate assessments of TEE.   

Validity of current recommended daily energy intakes in people with cirrhosis based on individual patient data

https://discovery.ucl.ac.uk/10139237/2/Morgan_AASLD%202021%20Validity.pdf

Validity of current recommended daily energy intakes in people with cirrhosis based on individual patient data

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