Energy requirements in hospitalized elderly people.

OBJECTIVES: To estimate energy intake and energy expenditure (EE) in elderly hospitalized patients recovering from an acute illness. DESIGN: Cross-sectional evaluation of the disparity between energy intake and expenditure. PARTICIPANTS: Ninety geriatric patients (mean age+/-standard deviation 79.7+/-7.5) admitted to acute care or rehabilitation units. MEASUREMENTS: Patients' energy intake and resting EE (REE) were measured over a 3-day period. Blood samples were taken to determine C-reactive protein (CRP), creatinine, and albumin concentrations and to check renal function. RESULTS: Energy intake was higher than REE by a factor of 1.29, but it was lower than the energy requirement. Energy intake, adjusted for differences in body weight, was independent of sex, highest in those who were malnourished (defined as a body mass index (BMI) <21), and lowest in patients who scored poorly on the Mini-Mental State Examination. Energy intake and REE were independent of plasma CRP, creatinine, and albumin concentrations, as well as the initial diagnosis. REE was similar in men and women, at 18.8 kcal/kg per day. REE was 21.4 kcal/kg per day in patients with a BMI of 21 or less and 18.4 kcal/kg per day in those with a BMI greater than 21 kg/m2. The Harris-Benedict equation accurately predicted mean REE. CONCLUSION: The mean REE of the geriatric patients studied was 18.8 kcal/kg per day, whereas energy intake was just sufficient to cover minimal requirements. Thus, hospitalized elderly patients are likely to benefit from higher calorie intake.

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.

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.