Recommendations Summary
UWL: Energy Needs 2009
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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Recommendation(s)
UWL: Estimating Energy Needs of Healthy Older Adults
When estimating energy needs for weight maintenance of healthy older adults, the Registered Dietitian (RD) should prescribe an energy intake of 25 - 35 kcal/kg/day in females and 30 - 40 kcal/kg/day in males. Research reports that applying physical activity levels ranging from 1.25 to 1.75 with measured RMR (via indirect calorimetry) in healthy older adults results in these mean total daily energy estimates.
Rating: Fair
ConditionalUWL: Estimating Energy Needs of Underweight Older Adults
When estimating energy needs for weight maintenance of underweight older adults, the Registered Dietitian (RD) should prescribe an energy intake of 25 - 30 kcal/kg/day, or higher energy levels for weight gain. Research reports that applying physical activity levels ranging from 1.25 to 1.5 with measured RMR (via indirect calorimetry) in older adults who are chronically or acutely ill and/or underweight results in these mean total daily energy estimates.
Rating: Weak
Conditional-
Risks/Harms of Implementing This Recommendation
- In some individuals, RMR estimation may be inadequate or excessive and clinical judgment should be used
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Conditions of Application
- Regarding the UWL: Estimating Energy Needs of Healthy Older Adults recommendation, this recommendation applies to healthy older adults.
- Regarding the UWL: Estimating Energy Needs of Underweight Older Adults recommendation, this recommendation applies to underweight older adults.
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Potential Costs Associated with Application
- A calculator is required for calculation of estimations
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Recommendation Narrative
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Regarding the UWL: Estimating Energy Needs of Healthy Older Adults recommendation, seven studies were evaluated regarding the caloric needs of healthy adults over age 65 (Ozeki et al, 2000; Rothenberg et al, 2000; Rothenberg et al, 2003; Luhrmann and Neuhauser-Berthold, 2004; Meunier et al, 2005; Rizzo et al, 2005; Nhung et al, 2007). As measured by indirect calorimetry, reported caloric needs of healthy adults range from 18 - 22 kcal/kg/day in females and 20 - 24 kcal/kg/day in males. Five studies were evaluated regarding the caloric needs of older adults who are acutely/chronically ill (Schneider et al, 2002; Sergi et al, 2002; Dambach et al, 2005; Gariballa and Forster, 2006; Lammes and Akner, 2006). As measured by indirect calorimetry, the caloric needs of acutely/chronically ill older adults range from 18 - 22 kcal/kg/day in females and 20 - 23 kcal/kg/day in males.
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Regarding the UWL: Estimating Energy Needs of Healthy Older Adults recommendation, five studies were evaluated regarding the physical activity factors with measured RMR in healthy older adults (Ozeki et al, 2000; Rothenberg et al, 2000; Rothenberg et al, 2002; Malatesta et al, 2003; Rothenberg et al, 2003; Blanc et al, 2004). The use of physical activity levels ranging from 1.25 (sedentary) to 1.75 (very active) resulted in mean total daily energy estimates of 25 - 35 kcal/kg/day in females and 30 - 40 kcal/kg/day in males.
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Regarding the UWL: Estimating Energy Needs of Underweight Older Adults recommendation, the caloric needs of underweight older adults (BMI < 20 kg/m2) may be as high as 27 - 28 kcal/kg/day (Schneider et al, 2002; Sergi et al, 2002).
- Regarding the UWL: Estimating Energy Needs of Underweight Older Adults recommendation, one study was evaluated regarding the physical activity factors with measured RMR in older adults who are acutely/chronically ill and/or underweight (Dambach et al, 2005). The use of physical activity levels ranging from 1.25 - 1.5 resulted in mean total daily energy estimates of 25 - 30 kcal/kg/day.
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Recommendation Strength Rationale
- Conclusion Statements in support of the UWL: Estimating Energy Needs of Healthy Older Adults recommendation received Grade II
- Conclusion Statements in support of the UWL: Estimating Energy Needs of Underweight Older Adults recommendation received Grades II and III
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Minority Opinions
Consensus reached.
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Risks/Harms of Implementing This Recommendation
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Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What are the caloric needs of healthy older adults (over age 65)?
What are the caloric needs of older adults (over age 65) who are acutely or chronically ill or underweight?
What are the reported activity level factors with measured RMR in healthy older adults?
What are the reported activity level factors with measured RMR in older adults who are acutely/chronically ill and/or underweight?-
References
Luhrmann PM, Neuhaeuser Berthold M. Are the equations published in literature for predicting resting metabolic rate accurate for use in the elderly? J Nutr Health Aging 2004;8(3):144-9.
Meunier N, Beattie JH, Ciarapica D, O'Connor JM, Andriollo-Sanchez M, Taras A, Coudray C, Polito A. Basal metabolic rate and thyroid hormones of late-middle-aged and older human subjects: the ZENITH study. Eur J Clin Nutr 2005;59:S53-S57.
Nhung BT, Khan NC, Hop LT, Lam NT, Khanh NLB, Lien DTK, Nakamori M, Hien VTT, Kassu A, Yamamoto S. Resting metabolic rate of elderly Vietnamese. Ann Nutr Metab 2007; 51:7-13.
Ozeki T, Ebisawa H, Ichikawa M, Nagasawa N, Sato F, Fujita Y. Physical activities and energy expenditures of institutionalized Japanese elderly women. J Nutr Sci Vitaminol 2000;46:188-192.
Rizzo MR, Mari D, Barbieri M, Ragno E, Grella R, Provenzano R, Villa I, Esposito K, Giugliano D, Paolisso G. Resting metabolic rate and respiratory quotient in human longevity. J Clin Endocrinol Metab 2005;90(1):409-13.
Rothenberg EM, Bosaeus IG, Westerterp KR, Steen BC. Resting energy expenditure, activity energy expenditure and total energy expenditure at age 91 - 96 years. Br J Nutr 2000;84:319-324.
Rothenberg EM, Bosaeus IG, Steen BC. Energy expenditure at age 73 and 78 - a five year follow up. Acta Diabetol 2003;40:S134-138.
Dambach B, Salle A, Marteau C, Mouzet JB, Ghali A, Favreau AM, Berrut G, Ritz P. Energy requirements are not greater in elderly patients suffering from pressure ulcers. J Am Geriatr Soc 2005;53:478-482.
Gariballa S, Forster S. Energy expenditure of acutely ill hospitalized patients. Nutr J 2006;5:9.
Lammes E, Akner G. Resting metabolic rate in elderly nursing home patients with multiple diagnoses. J Nutr Health Aging 2006;10(4):263-70.
Schneider SM, Al-Jaouni R, Pivot X, Braulio VB, Rampal P, Hebuterne X. Lack of adaptation to severe malnutrition in elderly patients. Clin Nutr 2002;21(6):499-504.
Sergi G, Coin A, Bussolotto M, Beninca P, Tomasi G, Pisent C, Peruzza S, Inelmen EM, Enzi G. Influence of fat-free mass and functional status on resting energy expenditure in underweight elders. J Gerontol A Biol Sci Med Sci 2002;57(5):M302-7.
Blanc S, Schoeller DA, Bauer D, Danielson ME, Tylavsky F, Simonsick EM, Harris TB, Kritchevsky SB, Everhart JE. Energy requirements in the eighth decade of life. Am J Clin Nutr 2004;79(2):303-10.
Malatesta D, Simar D, Dauvilliers Y, Candau R, Borrani F, Prefaut C, Caillaud C. Energy cost of walking and gait instability in healthy 65- and 80-year olds. J Appl Physiol 2003;95:2248-2256.
Rothenberg EM. Resting, activity, and total energy expenditure at age 91 - 96 compared to age 73. J Nutr Health Aging 2002;6(3):177-8. -
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
The Role of Nutrition in Pressure Ulcer Prevention and Treatment: National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel, 2009. Accessible at www.npuap.org..
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References