Is There a Role for Indirect Calorimetry in Maximizing Patient Outcome from Nutritional Alimentation in the Long-Term Nursing Care Setting?

Background: Patients in a long-term nursing care center (NCC) are at risk for the complications of malnutrition because of altered mental status and reduced mobility. Objective: This prospective study sought to determine the need for accurately measuring energy expenditure by indirect calorimetry (IC) and providing sufficient nutrition support, by evaluating the effect of energy balance on nutrition-related complications in the NCC. Design: Patients residing in one NCC were included in this study if there was evidence of hypoalbuminemia, pressure sores, weight loss, actual/ideal body weight less than 85% or more than 150%, or the need for enteral tube feeding or total parenteral nutrition (TPN). After 4 weeks of initial monitoring, patients were evaluated weekly by IC for 8 weeks. Caloric requirements were defined by the measured resting energy expenditure with 10% to 15% added for an activity factor. Monitors included: daily temperature and stool frequency; weekly calorie count, Norton scale (NS), weight, pressure sore number/stage, and serum prealbumin level; and monthly quality of life measure by Minimum Data Set. Results: Of 110 patients screened, 41 met study criteria but 17 were excluded for reasons of agitation, refusal to participate, discharge from the NCC, or death. Of the 24 patients completing the study, 20.8% were male with a mean age of 77.1 years (range 29 to 104 years) and could be grouped on the basis of energy balance. Group 1 (n = 13) had positive cumulative energy balance for the 8 weeks of the study, 30.8% lost weight, 53.8% showed a slight increase in their risk for pressure sores (as evidenced by decreases in NS score) but only 15.4% developed pressure sores. Group 2 (n = 11) had negative cumulative energy balance for the 8 weeks of the study, 63.6% lost weight (odds ratio [OR] = 0.25; 95%