Energy Expenditure

EE: Measurement Interval (2005)

• 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.
  • Evidence Summary: What is an acceptable energy measurement interval to accurately measure RMR?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Delikanaki-Skaribas E. The role of sampling duration on basal metabolic rate measurement error. Thesis dissertation. 2001 (1a).
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • Isbell TR, Klesges RC, Meyers AW, Klesges LM. Measurement reliability and reactivity using repeated measurements of resting energy expenditure with a face mask, mouthpiece and ventilated canopy. Journal of Parenteral and Enteral Nutrition. 1991; 15 (2): 165-168.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
      • van Lanschot JJB, Feenstra BWA, Vermeij CG, Bruining HA. Accuracy of intermittent metabolic gas exchange recordings extrapolated for diurnal variation. Crit Care Med. 1988; 16 (8): 737-742.
      • van Lanschot JJ, Feenstra BW, Vermeij CG, Bruining HA. Calculation versus measurement of total energy expenditure. Critical Care Medicine. 1986; 14: 981-985.
  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.
  • Evidence Summary: What is an acceptable energy measurement interval to accurately measure RMR?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Delikanaki-Skaribas E. The role of sampling duration on basal metabolic rate measurement error. Thesis dissertation. 2001 (1a).
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • Isbell TR, Klesges RC, Meyers AW, Klesges LM. Measurement reliability and reactivity using repeated measurements of resting energy expenditure with a face mask, mouthpiece and ventilated canopy. Journal of Parenteral and Enteral Nutrition. 1991; 15 (2): 165-168.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
      • van Lanschot JJB, Feenstra BWA, Vermeij CG, Bruining HA. Accuracy of intermittent metabolic gas exchange recordings extrapolated for diurnal variation. Crit Care Med. 1988; 16 (8): 737-742.
      • van Lanschot JJ, Feenstra BW, Vermeij CG, Bruining HA. Calculation versus measurement of total energy expenditure. Critical Care Medicine. 1986; 14: 981-985.
  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.
  • Evidence Summary: What is an acceptable energy measurement interval to accurately measure RMR?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Delikanaki-Skaribas E. The role of sampling duration on basal metabolic rate measurement error. Thesis dissertation. 2001 (1a).
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • Isbell TR, Klesges RC, Meyers AW, Klesges LM. Measurement reliability and reactivity using repeated measurements of resting energy expenditure with a face mask, mouthpiece and ventilated canopy. Journal of Parenteral and Enteral Nutrition. 1991; 15 (2): 165-168.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
      • van Lanschot JJB, Feenstra BWA, Vermeij CG, Bruining HA. Accuracy of intermittent metabolic gas exchange recordings extrapolated for diurnal variation. Crit Care Med. 1988; 16 (8): 737-742.
      • van Lanschot JJ, Feenstra BW, Vermeij CG, Bruining HA. Calculation versus measurement of total energy expenditure. Critical Care Medicine. 1986; 14: 981-985.
  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.
  • Evidence Summary: What is an acceptable energy measurement interval to accurately measure RMR?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Delikanaki-Skaribas E. The role of sampling duration on basal metabolic rate measurement error. Thesis dissertation. 2001 (1a).
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • Isbell TR, Klesges RC, Meyers AW, Klesges LM. Measurement reliability and reactivity using repeated measurements of resting energy expenditure with a face mask, mouthpiece and ventilated canopy. Journal of Parenteral and Enteral Nutrition. 1991; 15 (2): 165-168.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
      • van Lanschot JJB, Feenstra BWA, Vermeij CG, Bruining HA. Accuracy of intermittent metabolic gas exchange recordings extrapolated for diurnal variation. Crit Care Med. 1988; 16 (8): 737-742.
      • van Lanschot JJ, Feenstra BW, Vermeij CG, Bruining HA. Calculation versus measurement of total energy expenditure. Critical Care Medicine. 1986; 14: 981-985.
  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.
  • Evidence Summary: What is an acceptable energy measurement interval to accurately measure RMR?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Delikanaki-Skaribas E. The role of sampling duration on basal metabolic rate measurement error. Thesis dissertation. 2001 (1a).
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • Isbell TR, Klesges RC, Meyers AW, Klesges LM. Measurement reliability and reactivity using repeated measurements of resting energy expenditure with a face mask, mouthpiece and ventilated canopy. Journal of Parenteral and Enteral Nutrition. 1991; 15 (2): 165-168.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
      • van Lanschot JJB, Feenstra BWA, Vermeij CG, Bruining HA. Accuracy of intermittent metabolic gas exchange recordings extrapolated for diurnal variation. Crit Care Med. 1988; 16 (8): 737-742.
      • van Lanschot JJ, Feenstra BW, Vermeij CG, Bruining HA. Calculation versus measurement of total energy expenditure. Critical Care Medicine. 1986; 14: 981-985.