• Assessment
    In healthy adults, what is an acceptable energy measurement interval to reflect RMR?
    • Conclusion

      Setting: Community

      One large, high quality study measuring RMR in healthy adult women recommends a 10-minute measurement interval, with 10% CV in VO2 and VCO2/minute using steady state conditions excluding the first 5 minutes; and, a smaller study of women (using the same indirect calorimeter type) recommends a 20-minute measurement. Both studies report small mean RMR differences between 5-10 minute and longer measurement intervals.

       

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    According to one study of patients in a Veterans Health Administration transitional skilled care unit, what is an acceptable energy measurement interval to reflect RMR?
    • Conclusion

      Setting: Veterans Health Administration transitional skilled care unit (Sub-acute care)

      One study of moderate research quality in underweight and nonobese males residing in a Veterans Health Administration transitional skilled care unit report that a 20-minute measurement may be sufficient and result in a 210 kcals/day error.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    For patients in an acute care/trauma setting, what is an acceptable energy measurement interval to reflect RMR?
    • Conclusion

      Setting: Acute care/Trauma Setting

      Four high quality studies (with three studies using steady state protocol criteria*) were completed in critical care settings and recommended a 10-30 minute measurement length.+ Within these high quality studies, use of a 10-minute measurement achieved <10% difference from measured total energy expenditure. Critically ill patients with limited reliability in achieving steady state conditions will have a wider range of RMR variability.

       

      Measurement intervals can be altered by use of a steady state protocol criteria or collection device in all settings. * (pending other evidence analysis questions)

      +A group mean measurement length of ~11 minutes was needed to complete a 5-minute steady state protocol.

      * For a discussion on steady state or accuracy of measurement by gas collection devices, please refer to evidence conclusion statements for Question #1, sub letters “c” and “d.”

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    In older adults, what is an acceptable energy measurement interval to reflect RMR?
    • Conclusion

      Special Populations (Older Adults)

      There are insufficient studies to evaluate the applicability of the conclusion statement to oldest-old (i.e., populations aged 80 years or older). 

    • Grade: IV
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    In U.S.-residing non-white ethnic groups, what is an acceptable energy measurement interval to reflect RMR?
    • Conclusion

      Although minimal or no representation, this conclusion statement can be generalized to include U.S.-residing ethnic groups of African Americans, Asian and Pacific Islanders, American Indians, Alaskan Natives and Hispanic populations.

    • Grade: IV
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.