期刊
AMERICAN JOURNAL OF CLINICAL NUTRITION
卷 99, 期 4, 页码 792-803出版社
OXFORD UNIV PRESS
DOI: 10.3945/ajcn.113.069997
关键词
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资金
- National Institute of Neurological Disorders and Stroke [RO1 NS045087]
- General Clinical Research Center at Columbia [RR00645]
- General Clinical Research Center at Vermont [RR00109]
- General Clinical Research Center at Kentucky [RR02602]
- General Clinical Research Center at Utah [RR00064]
- General Clinical Research Center at Penn State [RR10732, CO6-RR016499]
- ALS Hope Foundation
- Cynthia Shaw Crispen Endowment
- Kevin Heidrich/Team 7 Endowment
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 6500 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. This trial was registered at clinicaltrials. gov as NCT00116558.
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