Energy requirements are not greater in elderly patients suffering from pressure ulcers.

OBJECTIVES: To estimate energy requirements in diseased elderly patients with pressure ulcers (PUs). DESIGN: Open, case-control study. SETTING: University Hospital of Angers (France). PARTICIPANTS: Twenty-nine patients with PUs (Norton index risk=14.3+/-3.3) and 27 controls hospitalized for various diseases (Norton=13.9+/-3.3). MEASUREMENTS: Energy requirements were estimated using measured resting metabolic rate (RMR) and multiplied by 1.26 and 1.5 to range between minimal World Health Organization (WHO) requirements and those of adults undergoing light physical activity. Energy intakes were estimated using 3-day food weight records. Measured RMR was compared with the prediction equations of Harris-Benedict, WHO, and Schofield. RESULTS: Measured RMR did not differ between the two groups (P=.48), and was not related to grade or size of the PUs. The WHO equation (82 kcal/d, P=.006) and the Schofield formula (57 kcal/d, P=.05) slightly underestimated calculated RMR, but the Harris-Benedict equation (40 kcal/d, P=.13) accurately estimated it. Energy requirements therefore ranged between 1,536+/-340 kcal/d and 1,828+/-405 kcal/d, (25-30 kcal/kg body weight per day). Energy intake was lower than energy requirements by 176 to 479 kcal/d. CONCLUSION: Diseased elderly patients with PUs do not have greater energy expenditure, with their requirements suggested to range between 25 and 30 kcal/kg body weight per day. Malnutrition within this population is most likely the result of low energy intake.

Estimation of calorie and protein intake in aged patients: validation of a method based on meal portions consumed.

BACKGROUND: Malnutrition is highly prevalent in hospital, mainly in geriatric, wards. Weight loss results from a negative energy balance, a situation where energy intake does not match energy requirements. Estimates of patient calorie consumption are not performed routinely because of technical difficulties. We performed three studies to investigate the meal-portion (MP) method as a tool for estimating calorie and protein intakes in clinical situations. METHODS: The MP method was designed to estimate calorie and protein consumption from the portion of the food items actually eaten by the patient, which is evaluated at the time plates and dishes are cleared away. Study 1 tested accuracy of the MP method in 50 meals by comparison to food weighing. Study 2 evaluated the validity of estimates obtained by a physician, a member of nursing staff, and a dietician in 30 elderly patients. Study 3 evaluated the robustness and feasibility of the method by comparing estimates obtained by nursing staff (after 1 year of practice with no additional training) and that of a dietician. RESULTS: Comparison of estimates and true values (obtained by weighing) showed a mean difference of -2 kcal/-0.8 g of protein from evaluations of one-half portions of food (50 meals) and -7 kcal/-1.0 g of protein from one-quarter portions of food; the difference was only significant for protein and one-quarter portions (p =.03). When evaluations were performed by observers of different professional categories (nursing staff, physicians, and dieticians) on actual meals consumed by 30 elderly people afflicted with disease, no statistical differences were shown. This interobserver agreement remained, regardless of the cognitive or physical status of the patient. A third study, performed after 1 year of no additional training, showed that the MP method is robust, but prone to clerical errors. CONCLUSIONS: Valid estimates of calorie and protein consumption can be obtained with the MP method, quoting in one-half portions. Quality controls are required both at the food production site (to avoid propagation of errors arising from food composition) and in data collection (to eliminate clerical mistakes). These results suggest that the MP method could be a tool for estimating calorie and protein intakes in many clinical situations.

Short-term effect of a protein load on appetite and food intake in diseased mildly undernourished elderly people.

BACKGROUND & AIMS: Malnutrition is a risk factor for mortality and various morbidities in the elderly. A low-energy intake often prevails and therapeutic interventions include the administration of dietary supplements, sometimes rich in proteins. We have tested the hypothesis that a protein-rich supplement inhibits appetite and decreases voluntary food intake. METHODS: Twelve mildly undernourished (BMI 21.3 +/- 2.4 kg/m2) elderly (84 +/- 7.8 yr) diseased persons were each studied under 3 conditions, in which they were given in random order at breakfast, and on consecutive days: either no supplement, a 250 kcal, 20 g protein supplement or a 250 kcal, 3.5 g protein supplement. Hunger, fullness, and desire to eat sensations were monitored half-hourly from before breakfast until lunch, and hourly from lunch until dinner. Food intake was assessed by weighing food before and after meals. Total energy and macronutrient intakes were calculated over 24 h. RESULTS: Both supplements increased energy intake (+185 kcal protein supplement, +176 kcal). Protein supplementation induced a net 17 g increase in protein intake (P < or = 0.0003). Neither supplement affected spontaneous food intake at lunch, dinner, or over the 24 h. Protein supplementation significantly depressed appetite in the breakfast to lunch period. CONCLUSION: A 250 kcal, 20 g protein supplement depresses hunger without affecting food intake in elderly diseased mildly undernourished persons.

Oral supplements differing in fat and carbohydrate content: effect on the appetite and food intake of undernourished elderly patients.

BACKGROUND & AIMS: Since fat, relative to other macronutrients, has low satiety and high energy density, it may have therapeutic application for supplementing energy intake. This study compared the effect of isoenergetic (1050 kJ) high fat or high carbohydrate oral supplements, given at breakfast, on the short-term appetite and energy intake in undernourished elderly subjects. METHODS: Sixteen hospitalised, undernourished (body mass index: 20 +/- 3 kg/m2), elderly (77 +/- 8 yr) people were randomly allocated to a control or 1 of 2 supplement groups [fat: carbohydrate: protein (% energy) was 70:25:5 or 25:70:5]. In each group, energy intake (24-h food consumption) and appetite (visual analogue scales) were assessed over 3 consecutive days. RESULTS: Mean energy intake significantly (P = 0.0035) increased following supplementation: high fat 6973 kJ/d, high carbohydrate 6906 kJ/d vs. control 6079 kJ/d but mean voluntary 24-h energy intake remained unaffected. Compared to controls, supplemented subjects experienced reduced hunger (P = 0.07) between breakfast and lunch, but showed no difference over the whole day (P = 0.55). CONCLUSIONS: Under these study conditions a 1050 kJ oral supplement, irrespective of macronutrient composition, does not cause voluntary short-term energy intake compensation in undernourished elderly people.