The measurement and estimation of total energy expenditure in Japanese patients with ALS: a doubly labelled water method study

Abstract

Appropriate nutritional therapy has not been established for patients with amyotrophic lateral sclerosis (ALS). Our objective was to measure the total energy expenditure (TEE) and determine an equation to estimate the energy requirements for Japanese patients with ALS. Twenty-six Japanese patients with ALS participated in the study. The TEE was measured using the doubly labelled water (DLW) method for a 14-day period. Using a range of clinical parameters and multiple regression analyses, we determined an adequate equation to calculate TEE. Results showed that the median value of total energy intake (TEI) was 1581 (interquartile 1278–1782) kcal/d. TEE and TEE/body weight were 1628 kcal/d (1352–1865) and 31.3 kcal/kg (29.2–34.4), respectively. The ratio of TEE/estimated TEE by the Harris-Benedict equation was 1.14 (1.09–1.26). The difference between TEI and TEE was –63 kcal (–221 – 122), and 15 patients (57.7%) showed a negative balance. From regression analyses, we determined an equation to estimate TEE using the resting metabolic rate estimated by the Harris-Benedict equation (RMR-HB) and scores of the revised ALS Functional Rating Scale (ALSFRS-R): TEE = (1.67 × RMR-HB) + (11.8 × ALSFRS-R) – 680 (p < 0.0001). In conclusion, energy expenditure of Japanese patients with ALS was higher than expected, and we proposed a preliminary equation to estimate TEE for future nutritional intervention.

Key words:

• Amyotrophic lateral sclerosis
• total energy expenditure
• doubly labelled water
• nutritional requirements
• regression analysis

Acknowledgements

We thank Tokiko Matsukura and Megumi Tsuchiya for their measurement of TEI in the patients. This study was supported by a Grant-in-Aid for a ‘Research Committee on the Improvement of Medical Care and the Organization of Supporting Systems for Patients with Rare Diseases’ (2011–2013) from the Ministry of Health, Labour, and Welfare of Japan, and also in part by a Grant-in-Aid for the ALS and Neuropathy Project from the Tokyo Metropolitan Institute of Medical Science.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper