FNCE 2023
Session 357. Providing MNT for the Pediatric Type 1 Diabetes Population: What Does the Evidence Show?
Monday, October 9, 8:30 AM - 9:30 AM

See session information ♦ See EAL review results

# Chronic Obstructive Pulmonary Disease

## Individual Predictive Equations (2019)

Evidence for Predictive Equations

Eleven equations were tested for validity in predicting resting metabolic rate (RMR) in adults with COPD. Three methods for predicting total energy expenditure (TEE) in adults with COPD were also tested.

The evidence for each prediction method for RMR and TEE is below. For a summary of all predictive methods below, see Summary of All Predictive Equations (2019) in Methods to Estimate Energy Requirements (2019) in the left navigation bar.

• Assessment
In adults with COPD, how does the body weight equation (kcal per kg) relate to measured energy expenditure?
• Conclusion

Limited evidence suggests that the body weight equation (30kcal per kg) is probably* an unbiased estimate of total energy expenditure (TEE) in adults with COPD. Limit of agreement was 47% of the mean measured and predicted TEE.

* This statement must be qualified because bias was not reported directly in these studies, but is inferred from mean predicted TEE compared to mean measured TEE.

• 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: In adults with COPD, how does the body weight equation (kcal per kg) relate to measured energy expenditure?
In adults with COPD, how does the de Oliveira equation relate to measured energy expenditure?
In adults with COPD, how does the Harris-Benedict equation (HBE) relate to measured energy expenditure?
• Conclusion

Evidence suggests that the Harris-Benedict equation is probably* unbiased, but might over-estimate resting metabolic rate (RMR) in adults with COPD. Accuracy was 61% and limit of agreement was about ±20% of mean RMR. When the HBE for RMR was used as the basis for calculating TEE, an accuracy rate of 50% was achieved.

* This statement must be qualified because bias was not reported directly in these studies but is inferred from mean predicted RMR, compared to mean measured RMR.

• 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: In adults with COPD, how does the Harris-Benedict equation (HBE) relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017

In adults with COPD, how does the Mifflin St. Jeor equation (MSJE) relate to measured energy expenditure?
In adults with COPD, how does the Moore and Angellilo equation (MAE) relate to measured energy expenditure?
• Conclusion

Evidence suggests that the Moore and Angellilo (MAE) equation is probably* biased toward over-estimation of resting metabolic rate (RMR) in adults with COPD. Accuracy was 51% and limit of agreement was about -28% to +10% of mean RMR (in this case the negative value is over-estimation). When the MAE for RMR was used as the basis for calculating total energy expenditure (TEE), an accuracy rate of 50% was achieved (this required measurement of physical activity with a pedometer).

* This statement must be qualified because bias was not reported directly in these studies but is inferred from mean predicted RMR, compared to mean measured RMR.

• 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: In adults with COPD, how does the Moore and Angellilo equation (MAE) relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017

In adults with COPD, how does the Nordenson equation relate to measured energy expenditure?
• Conclusion

Limited evidence suggests that the Nordenson equation is probably* unbiased but might underestimate resting metabolic rate (RMR) in adults with COPD. Limit of agreement was ±19% of mean RMR. When the Nordenson equation for RMR was used as the basis for calculating total energy expenditure (TEE), an accuracy rate of 22% was achieved (this required measurement of physical activity with a pedometer).

* This statement must be qualified because bias was not reported directly in these studies, but was inferred from mean predicted RMR, compared to mean measured RMR.

• 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: In adults with COPD, how does the Nordenson equation relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017

In adults with COPD, how does the Nordic Nutrition Recommendation equation (NNRE) relate to measured energy expenditure?
• Conclusion

Limited evidence suggests that the Nordic Nutrition Recommendation equation (NNRE) is probably* biased toward over-estimation of RMR in adults with COPD. When the NNRE for resting metabolic rate (RMR) was used as the basis for calculating total energy expenditure (TEE), an accuracy rate of 50% was achieved (this required measurement of physical activity with a pedometer).

* This statement must be qualified because bias was not reported directly in these studies, but was inferred from mean predicted RMR compared to mean measured RMR.

• 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: In adults with COPD, how does the Nordic Nutrition Recommendation equation (NNRE) relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017

In adults with COPD, how does the Owen equation relate to measured energy expenditure?
In adults with COPD, how does the Schofield equation relate to measured energy expenditure?
• Conclusion

Limited evidence suggests that the Schofield equation is probably* biased toward over-estimation of resting metabolic rate (RMR) in adults with COPD. When the Schofield equation for RMR was used as the basis for calculating total energy expenditure (TEE), an accuracy rate of 56% was achieved (this required measurement of physical activity with a pedometer).

* This statement must be qualified because bias was not reported directly in the study but was inferred from mean predicted RMR, compared to mean measured RMR.

• 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: In adults with COPD, how does the Schofield equation relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017

In adults with COPD, how does the Westerterp equation relate to measured energy expenditure?
• Conclusion

Limited evidence suggests that the Westerterp equation is probably* unbiased, but might over-estimate resting metabolic rate (RMR) in adults with COPD. Accuracy was 68%, with a limit of agreement -23% to +18% of mean RMR.

* This statement must be qualified because bias was not reported directly in these studies, but was inferred from mean predicted RMR compared to mean measured RMR.

• 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: In adults with COPD, how does the Westerterp equation relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017

In adults with COPD, how does the WHO (including height) equation relate to measured energy expenditure?
• Conclusion

Limited evidence suggests that the World Health Organization [WHO (including height)] equation is probably* unbiased, but might under-estimate resting metabolic rate (RMR) in adults with COPD. Accuracy was 63% and limit of agreement was about ±25% of mean RMR.

* This statement must be qualified because bias was not reported directly in the one study that indicated no difference between the equation and measured RMR value. Lack of bias has been inferred from this lack of significant difference between mean predicted and measured RMR.

• 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: In adults with COPD, how does the WHO (including height) equation relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017

In adults with COPD, how does the WHO (omitting height) equation relate to measured energy expenditure?
• Conclusion

Limited evidence suggests that the World Health Organization (omitting height) equation [WHO (omitting height) equation] is probably* biased toward over-estimation of resting metabolic rate (RMR), but might under-estimate RMR in adults with COPD. Limit of agreement (LOA) was +18% of mean RMR, but could be as wide as -66% to +24% of mean RMR. When the WHO (omitting height) equation for RMR was used as the basis for calculating TEE, an accuracy rate of 67% was achieved (this required measurement of physical activity with a pedometer). When the equation was multiplied by 1.7 to approximate TEE, a mean 16% over-estimation occurred (i.e., the method is probably** biased toward over-estimation) and the LOA was 45% of the mean between measured and predicted TEE.

* This statement must be qualified because bias was not reported directly in these studies, but is inferred from mean predicted RMR, compared to mean measured RMR.
** This statement must be qualified because bias was not reported directly in these studies but is inferred from mean predicted TEE, compared to mean measured TEE.

• 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: In adults with COPD, how does the WHO (omitting height) equation relate to measured energy expenditure?
• Search Plan and Results: COPD: Methods to Estimate Energy and Protein Requirements 2017