老年住院人群的静息热量预测公式:间接测热法与13种公式预测法的一致性研究

A formula to predict the resting energy expenditure of hospitalized older adults:a consistency study between the indirect calorimetry measurement and 13 formulas

张瑞英 ¹赵岩妍 ²倪琛琛 ³侯平 ⁴范丽丽 ⁵董明 ⁶张黎 ⁷赵春梅 ⁸吴聪 ⁹周起 ¹⁰武文斌¹¹

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作者信息

1. 衡水市人民医院肾内科,衡水 053000
2. 北京优联医院老年科,北京 100023
3. 合肥市第一人民医院老年科,合肥 230061
4. 兴安盟人民医院老年医学科,乌兰浩特 137499
5. 深圳市中医院老年医学科,深圳 518033
6. 盘锦辽油宝石花医院老年病科,盘锦 124009
7. 云南省第一人民医院老年科,昆明 650034
8. 山东省泰山医院老年医学科,泰安 271099
9. 郑州大学第一附属医院老年内分泌科,郑州 450052
10. 北京医院国家老年医学中心国家卫生健康委北京老年医学研究所国家卫生健康委老年医学重点实验室中国医学科学院老年医学研究院,北京 100730
11. 北京医院老年科国家老年医学中心中国医学科学院老年医学研究院,北京 100730
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摘要

目的探讨既往静息热量(REE)预测公式的准确性,并开发一款适合住院老年人的REE预测公式.方法基于横断面数据的一致性研究,纳入2022年10月1日至2023年11月31日于北京医院老年医学科住院的老年人,通过性别、年龄、体质指数(BMI)、血压等和静息热量相关的参数,计算Harris-Benedict等13,种老年人常用公式静息热量预测值(pREE).以间接测热法测量值(mREE)为金标准,并比较各pREE和mREE的组间差异,计算组内相关系数(ICC)以及准确率(以±10％mREE值为参考).利用十折交叉验证方法筛选有效变量,构建新预测公式,并比较其和金标准、Harris-Benedict、欧洲肠外肠内营养学会(ESPEN)以及中国肠外肠内营养学会(CSPEN)推荐公式的性能.结果共纳入223例住院老年人,年龄60～98(79.5±8.2)岁,男性占49.3％(110例),衰弱老年人比例约84.3％(188例).14个公式预测的pREE和金标准mREE结果差异较大(中位差值9.1～232.1 kcal/d).Harris-Benedict、DESPEN、CSPEN 预测值和 mREE 的差异有统计学意义(均 P＜0.05),准确率仅分别为30.9％、31.4％及24.7％.新开发公式为:pREE=794.847+8.661 ×体重-7.976× 年龄+14.757 × 握力+5.037 × 心率,ICC(95％CI)系数为 0.6(0.5～0.7),准确率为56.3％.结论常见公式在住院老年人中预测REE的性能较差,新开发的公式性能优于既往公式,可作为该人群预测静息热量的参考方法.

Abstract

Objective To investigate the accuracy of resting energy expenditure(REE)prediction formulas and to develop a new REE prediction formula suitable for hospitalized older adults.Methods Older adults hospitalized in the Department of Geriatrics from October 1,2022,to November 31,2022,were included in the study.The predicted values of REE(pREE)were estimated using 13 commonly employed formulas that incorporate parameters related to resting energy expenditure,such as gender,age,body mass index(BMI),and body weight.Indirect calorimetry measurements(mREE)served as the gold standard for comparison.Group differences between pREE and mREE,the coefficient of concordance(ICC),and accuracy(defined as±10％of the mREE values)were utilized to evaluate the performance of the formulas.The ten-fold cross-validation method was employed to identify valid variables and to construct a new prediction formula.The performance of this new formula was compared to mREE,the Harris-Benedict formula,the European Society of Clinical Nutrition and Metabolism(ESPEN)formula,and the Chinese Society of Clinical Nutrition and Metabolism(CSPEN)formula.Results A total of 223 hospitalized participants aged 60 to 98 years(mean age 79.5±8.2 years)were included in the study.Among these participants,49.3％(110 cases)were male,and the prevalence of frailty was approximately 84.3％(188 cases).The median difference between pREE and mREE ranged from 9.1 to 232.1 kcal/d.The predictions from the Harris-Benedict,ESPEN,and CSPEN equations differed significantly from mREE(all P＜0.05),with respective accuracies of 30.9％,31.4％,and 24.7％.A new equation was developed:pREE=794.847+8.661 × body weight-7.976 × age+14.757 × grip strength+5.037 × heart rate,with an ICC of 0.6(95％CI:0.5-0.7),and the accuracy reached 56.3％.Conclusions Existing equations demonstrate low accuracy in predicting REE among hospitalized older adults.The newly developed equation shows improved performance compared to previous models and can serve as a reference method for predicting REE in this demographic.

关键词

住院患者/静息热量/间接测热法/预测静息热量

Key words

Inpatients/Rest energy expenditure/Indirect calorimetry/Predicted rest energy expenditure

引用本文复制引用

出版年

2024

中华老年医学杂志

中华医学会

中华老年医学杂志

CSTPCD北大核心

影响因子：1.606

ISSN：0254-9026

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