Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis

Edward J. Kasarskis, Marta S. Mendiondo, Dwight E. Matthews, Hiroshi Mitsumoto, Rup Tandan, Zachary Simmons, Mark B. Bromberg, Richard J. Kryscio

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Patients with amyotrophic lateral sclerosis (ALS) experience progressive limb weakness, muscle atrophy, and dysphagia, making them vulnerable to insufficient energy intake. Methods to estimate energy requirements have not been devised for this patient group. Objective: The goal was to develop equations to estimate energy requirements of ALS patients. Design: We enrolled 80 ALS participants at varying stages of their illness and studied them every 16 wk over 48 wk. At each time, we determined total daily energy expenditure (TDEE) in the home setting over a 10-d period by using the doubly labeled water method. We then developed statistical models to estimate TDEE by using factors easily obtained during a routine clinical visit. Results: The most practical TDEE models used the Harris-Benedict, Mifflin-St Jeor, or Owen equations to estimate resting metabolic rate (RMR) and 6 questions from the revised ALS Functional Rating Scale (ALSFRS-R) that relate to physical activity. We developed a Web-based calculator to facilitate its use. In the research setting, measuring body composition with bioelectrical impedance spectroscopy enabled the estimation of RMR with the Rosenbaum equation and the same 6 questions from the ALSFRS-R to estimate TDEE. By using these models, the estimate of TDEE for nutritional maintenance was ±500 kcal/d across the spectrum of ALS progression. Conclusions: Our results emphasize the importance of physical function and body composition in estimating TDEE. Our predictive equations can serve as a basis for recommending placement of a feeding gastrostomy in ALS patients who fail to meet their energy requirements by oral intake. This trial was registered at clinicaltrials.gov as NCT00116558.

Original languageEnglish (US)
Pages (from-to)792-803
Number of pages12
JournalAmerican Journal of Clinical Nutrition
Volume99
Issue number4
DOIs
StatePublished - Apr 1 2014

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Amyotrophic Lateral Sclerosis
Energy Metabolism
Basal Metabolism
Body Composition
Dielectric Spectroscopy
Gastrostomy
Muscular Atrophy
Statistical Models
Deglutition Disorders
Energy Intake
Electric Impedance
Extremities
Maintenance
Exercise
Water
Research

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Kasarskis, E. J., Mendiondo, M. S., Matthews, D. E., Mitsumoto, H., Tandan, R., Simmons, Z., ... Kryscio, R. J. (2014). Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis. American Journal of Clinical Nutrition, 99(4), 792-803. https://doi.org/10.3945/ajcn.113.069997
Kasarskis, Edward J. ; Mendiondo, Marta S. ; Matthews, Dwight E. ; Mitsumoto, Hiroshi ; Tandan, Rup ; Simmons, Zachary ; Bromberg, Mark B. ; Kryscio, Richard J. / Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis. In: American Journal of Clinical Nutrition. 2014 ; Vol. 99, No. 4. pp. 792-803.
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Kasarskis, EJ, Mendiondo, MS, Matthews, DE, Mitsumoto, H, Tandan, R, Simmons, Z, Bromberg, MB & Kryscio, RJ 2014, 'Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis', American Journal of Clinical Nutrition, vol. 99, no. 4, pp. 792-803. https://doi.org/10.3945/ajcn.113.069997

Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis. / Kasarskis, Edward J.; Mendiondo, Marta S.; Matthews, Dwight E.; Mitsumoto, Hiroshi; Tandan, Rup; Simmons, Zachary; Bromberg, Mark B.; Kryscio, Richard J.

In: American Journal of Clinical Nutrition, Vol. 99, No. 4, 01.04.2014, p. 792-803.

Research output: Contribution to journalArticle

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N2 - Background: Patients with amyotrophic lateral sclerosis (ALS) experience progressive limb weakness, muscle atrophy, and dysphagia, making them vulnerable to insufficient energy intake. Methods to estimate energy requirements have not been devised for this patient group. Objective: The goal was to develop equations to estimate energy requirements of ALS patients. Design: We enrolled 80 ALS participants at varying stages of their illness and studied them every 16 wk over 48 wk. At each time, we determined total daily energy expenditure (TDEE) in the home setting over a 10-d period by using the doubly labeled water method. We then developed statistical models to estimate TDEE by using factors easily obtained during a routine clinical visit. Results: The most practical TDEE models used the Harris-Benedict, Mifflin-St Jeor, or Owen equations to estimate resting metabolic rate (RMR) and 6 questions from the revised ALS Functional Rating Scale (ALSFRS-R) that relate to physical activity. We developed a Web-based calculator to facilitate its use. In the research setting, measuring body composition with bioelectrical impedance spectroscopy enabled the estimation of RMR with the Rosenbaum equation and the same 6 questions from the ALSFRS-R to estimate TDEE. By using these models, the estimate of TDEE for nutritional maintenance was ±500 kcal/d across the spectrum of ALS progression. Conclusions: Our results emphasize the importance of physical function and body composition in estimating TDEE. Our predictive equations can serve as a basis for recommending placement of a feeding gastrostomy in ALS patients who fail to meet their energy requirements by oral intake. This trial was registered at clinicaltrials.gov as NCT00116558.

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