Newsletter

[ Vol. 6 No. 2 ] (May - August 2005 )
Prognostic value of energy metabolism

Hisataka Moriwaki, Hideki Fukushima, Makoto Shiraki, Nobuo Murakami*
Department of Internal Medicine and *Nutritional Support Team, Gifu University
School of Medicine, Japan

Nutritional support for energy metabolism is a fundamental intervention for critically ill patients in intensive care units. Whether or not a particular patient is in energy malnutrition can be determined using anthropometrical parameters such as arm circumference (AC), triceps skin fold thickness (TSF), and calf circumference (CC). Precise analysis of energy metabolism can be done by indirect calorimetry with indices as resting energy expenditure (REE) and respiratory quotient (RQ). For example in decompensated liver cirrhosis, low RQ appears due to decreased use of carbohydrate for oxygen generation. Such alteration in energy metabolism is induced by the lack of glycogen store in the liver and insulin resistance of peripheral tissues including skeletal muscle. PEM determines survival of decompensated cirrhotic patients. Thus, not only in liver diseases but also in general, nutritional support is essential for energy malnutrition to raise the survival rate. Correction of energy metabolism is done based on calculated energy prescription according to Harris- Benedict formula or more precisely, by measuring directly the REE of the patient. Adequate energy supplementation helps adjusting the energy metabolism in critically ill patients, and improving their general condition. Enteral nutrition with preformed mixture is more desirable in most patients while parenteral nutrition may be indicated exceptionally.

From  
“The Future of Nutrition Support and Cooperation Among the Asian Regions”
The 10^th PENSA Congress, Dusit Resort Pattaya, Chonburi, Thailand. 
October 27-29, 2004: Page 69