Estimating energy requirements in hospitalised underweight and obese patients requiring nutritional support: a survey of dietetic practice in the United Kingdom

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BACKGROUNDMany methods are available to determine energy requirements, however, all have limitations, particularly when used for the obese.OBJECTIVESThe aim of this survey was to investigate current practice in the estimation of energy requirements in an underweight and obese hospitalised patient in a large cohort of UK dietitians.SUBJECT/METHODSA cross-sectional anonymous online survey of UK registered dietitians was performed.RESULTSA total of 672 responses were received. Underweight patient: prediction equations with adjustment for metabolic stress and physical activity were most commonly used (90%). The median estimated energy requirement was 2079 kcals/day. The estimated energy requirement using calorie per kilogram method was significantly lower compared with equations (P<0.001). The median target volume of feed prescribed was 2000 mls/day. A significant reduction in feed prescribed compared with estimated energy requirements was found (P<0.001). Obese patient: prediction equations to estimate the basal metabolic rate alone were most commonly used (51%). Nutrition support dietitians used a lower stress factor compared with non-nutrition support dietitians (P=0.016). Method used to estimate the energy requirements was associated with years in clinical practice and place of work (P<0.001, 0.001). Calorie per kilogram used in the obese case study (median: 25 kcal/kg) was significantly lower than calorie per kilogram used in the underweight case study (median: 30 kcal/kg; P=0.014).CONCLUSIONSA significant variation in the methods used by dietitians to estimate the energy requirements was found, particularly in the obese patient group. In an age of rapidly increasing rates of obesity a professional consensus of treatment of this patient group is needed.

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