Nutrición Hospitalaria (Dec 2005)
Estudio del gasto energético en la anorexia nerviosa: concordancia entre calorimetría indirecta y diferentes ecuaciones Study of energy expenditure in anorexia nervosa: agreement between indirect calorimetry and several equations
Abstract
El tratamiento nutricional es fundamental en la anorexia nerviosa (AN), si bien la reposición de nutrientes debe hacerse de forma progresiva para evitar la aparición del síndrome de realimentación. Objetivo: Comparar el gasto energético en reposo (GER) mediante calorimetría indirecta con el estimado con diferentes fórmulas en mujeres con AN. Material y Métodos: Estudiamos 21 mujeres ingresadas con AN (DSM-IV), edad 17 (DE 5,9) rango 12-34 años. El tiempo de ingreso fue 55,1 ± 20,7 días (21-91). La valoración nutricional inicial incluyó antropometría (IMC, PTC, PSE, CMB,CMMB) y bioimpedancia tetrapolar (HoltainBC). La calorimetría indirecta (CI) se realizó tras ayuno nocturno (Deltatrac TM II MBM-200). En 9 pacientes se repitió el mismo estudio antes del alta. Comparamos el GER (kcal/24 h) medido por CI con el obtenido por diferentes ecuaciones [Fleisch, Harris-Benedict (HB), FAO, Schofield-HW (SHW), Schebendach] mediante el coeficiente de correlación intraclase (CCI) y el método de Bland y Altman. Resultados: El estado nutricional mejoró significativamente durante la hopitalización. El 50% del peso recuperado fue masa grasa. El GER aumentó significativamente durante el ingreso. Las fórmulas sobrestimaron el GER respecto al obtenido por CI (p Nutritional management is essential in anorexia nervosa (AN), although nutrient replenishment must be done progressively to prevent the occurrence of re-alimentation syndrome. Objective: to compare resting energy expenditure (REE) by means of indirect calorimetry and by different equations in AN female patients. Material and methods: we studied 21 women admitted for AN (DSM-IV), mean age 17 years (SD 5.9), range 12-34 years. Admission stay was 55.1 ± 20.7 days (21-91). Initial nutritional assessment included anthropometrics (BMJ, TSF, SSE, MAC, MAMC) and tetrapolar bioimpedance (HoltainBC). Indirect calorimetry (IC) was done after overnight fasting (DeltatracTM II MBM-200). In 9 patients, the same study was repeated before hospital discharge. We compared REE (Kcal/24 h) measured by IC with that obtained by several equations [Fleish, Harris- Benedict, FAO, Schofield-HW (SHW), Schebendach] through the intraclass correlation coefficient (ICC) and the Bland-Altman method. Results: Nutritional status significantly improved during hospital admission. Fifty percent of the recovered weight was fat mass. REE significantly increased during admission. The equations overestimated REE as compared to IC (p < 0.05), except for the Schebendach equation that underestimated REE. The agreement between direct measurement of REE by IC and its estimation through equations was poor [Fleish (ICC = 0.21); HB (ICC = 0.21), SHW (ICC = 0.19), Schebendach (ICC = 0.15)]. Through the Bland-Altman method, we observed that there was a variable bias between IC and equations, with a clinically acceptable agreement for REW values of around 1200 Kcal/day. Conclusions: 1) In our study we obtained a poor agreement between REW values measured by indirect calorimetry and those estimated by equations. 2) Through the Bland-Altman method, we observed that all equations present a variable bias as for IC, the agreement being clinically acceptable for REE values of around 1200 Kcal/day. 3) Thus, indirect calorimetry seems to be a very useful tool to calculate the energy requirements of anorexia nervosa patients.
