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Energy Expenditure

EE: Scope of Guideline (2014)

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

The Guideline is intended to be used by the registered dietitian nutritionist (RDN) and other trained health professionals involved in the nutritional care of healthy and non-critically ill individuals. The recommendations are intended to provide healthcare practitioners with guidance and direction based on the current scientific evidence for measuring resting metabolic rate (RMR) in healthy and non-critically ill individuals in order to promote positive clinical outcomes.

The Guideline assumes that the practitioner conducting RMR measurements is trained on the specific indirect calorimetry device used in the facility and has achieved technical competency. In addition, it is assumed that the practitioner is familiar with the facility's protocol and privileges for measuring RMR.

Guideline Category

Technology Assessment

Clinical Specialty

Nutrition

Intended Users

Registered Dietitians, Advanced Practice Nurses, Allied Health Personnel, Nurses, Physician Assistants, Physicians, Respiratory Care Practitioners, Students

Guideline Objective(s)

Overall Objective

To help the practitioner identify the conditions under which she/he can perform an indirect calorimetry measurement to accurately measure RMR in healthy and non-critically ill individuals and properly interpret the results. 

Specific Objectives

  • To define evidence-based recommendations for the measurement of RMR, using indirect calorimetry by RDNs in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical and nutritional elements
  • To reduce variations in measurement practices among RDNs
  • To provide the RDN with evidence-based practice recommendations to adjust the medical nutrition therapy (MNT) or recommend other therapies to achieve positive outcomes
  • To promote optimal nutrition within cost constraints of the healthcare environment.
Note: This guideline does not address methods for estimating TEE from RMR, nor how frequently RMR measured should be conducted, as methods will vary based on specific populations and conditions (healthy, chronic disease, weight status, acute illness), among many other variables.

Target Population

Pre-school Child (2 to 5 years), Child (6 to 12 years), Adolescent (13 to 18 years), Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Healthy and Non Critically ill individuals

The majority of studies used in the development of this guideline were conducted on healthy adults. A few of the recommendations also included one study conducted on healthy children (age 7 to 12 years) and four studies of adults with chronic disease, but who were not critically ill. Adult subjects in the non-critically ill population included patients with COPD, stable hospitalized patients (mostly fractures), individuals undergoing an elective thoracotomy, and stable cancer patients. There were no studies of non-critically ill children included.

Future Research Needs

Additional research is needed in healthy and non-critically ill populations to:
 
Clarify:

  • The effect of different gas collection devices on RMR.
  • The effect of diurnal (time of day) variation on RMR.
  • The thermoneutral room temperature range and the effect of increased room temperature on RMR
  • The duration of time after consumption of a meal that is required for the RMR to return to baseline
  • The time required for RMR to return to baseline after consumption of meals of various sizes
  • The duration of elevated RMR after ingestion of caffeine and other stimulants is needed.
  • The effect of nicotine-containing products on RMR
  • The time an individual should refrain from light, moderate, or vigorous intensity physical activity prior to an RMR measurement

Interventions and Practices Considered

The Evidence-Based Nutrition Practice Guideline for Measuring Resting Metabolic Rate (RMR) in the Healthy and Non-Critically Ill is based on the Academy of Nutrition and Dietetics' Nutrition Care Process and Model, which involves the following steps. Terms relevant to the treatment of healthy and non-critically ill individuals come from the International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process. Fourth Edition.

  • Nutrition Assessment
  • Nutrition Diagnosis
  • Nutrition Intervention
  • Nutrition Monitoring and Evaluation.
This guideline addresses topics that correspond to the following areas of the Nutrition Care Process.
 
I. Referral to a Registered Dietitian Nutritionist
II. Medical Nutrition Therapy.

A. Nutrition Assessment

Click here to view the complete list of nutrition assessment terms from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Fourth Edition.

B. Nutrition Diagnosis

Click here to view the complete list of nutrition diagnoses-related terms from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Fourth Edition

C. Nutrition Intervention (Planning and Implementation)

Individualized nutrition prescription is based on current reference standards and dietary guidelines and the patient/client’s health condition and nutrition diagnosis:
  • Formula/solution 
  • Nutritional needs of patient
  • Medical status
  • Current clinical status
  • Total energy estimated needs
  • Methods for estimating needs.
Click here to view the complete list of nutrition intervention terms from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Fourth Edition.

D. Monitoring and Evaluation

Monitoring and evaluation are critical components in reassessing the adequacy and success of the nutrition support intervention.

Click here to view the complete list of nutrition monitoring and evaluation terms from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Fourth Edition.