Energy requirement assessed by doubly-labeled water method in patients with advanced amyotrophic lateral sclerosis managed by tracheotomy positive pressure ventilation

Abstract

This study aimed to clarify the energy requirement in patients with amyotrophic lateral sclerosis (ALS) undergoing tracheostomy positive pressure ventilation with tracheostomy. Total energy expenditure (TEE) was measured in 10 hospitalized bedridden ALS patients using the doubly-labeled water (DLW) method. The mean TEE/day and TEE/fat- free mass estimated by DLW method were 934 ± 201 kcal/day and 34.8 ± 5.5 kcal/kg/day, respectively. The mean TEE/resting metabolic rate (RMR) was 0.85 when RMR was estimated by the Harris-Benedict equation, 0.91 by Dietary Reference Intake (DRI), and 0.97 by Ganpule's equation using fat-free mass (FFM). The ratios of TEE to measured RMR were 1.05, 1.15 and 1.23 in three patients. In conclusion, multiplying measured RMR by 1.1 to 1.2 is considered to be appropriate to estimate energy need. However, because it is difficult to measure RMR directly in a clinical setting, an appropriate equation for estimating RMR for ALS patient should be developed.

Key words::

• Amyotrophic lateral sclerosis
• total energy expenditure (TEE)
• doubly-labeled water (DLW)
• resting metabolic rate (RMR)
• fat-free mass (FFM)
• tracheotomy positive pressure ventilation (TPPV)

Declaration of interest: This work financially support by Morinaga Milk Industry Co. Ltd. None of the other authors declare of interests related to this study. The authors alone are responsible for the content and writing of the paper.