Early postoperative alterations in infant energy use increase the risk of overfeeding
Aim of Study: Energy needs in infants are decreased after surgery because of growth inhibition (resulting from catabolic stress metabolism), decreased insensible losses, and inactivity. Using standardized formulas that account for growth, activity, and insensible losses during this stress period can...
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| Veröffentlicht in: | Journal of pediatric surgery 1995-07, Vol.30 (7), p.988-993 |
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| creator | Letton, Robert W Chwals, Walter J Jamie, Angela Charles, Barbara |
| description | Aim of Study: Energy needs in infants are decreased after surgery because of growth inhibition (resulting from catabolic stress metabolism), decreased insensible losses, and inactivity. Using standardized formulas that account for growth, activity, and insensible losses during this stress period can lead to overfeeding in excess of 200% of the actual measured requirement. Overfeeding during this acute injury period can result in increased CO
2 production from lipogenesis. This study determined the effects of a reduced rate of mixed caloric repletion on infant energy use during the early postoperative period.
Methods: C-reactive protein (CRP), oxygen consumption (VO
2), carbon dioxide production (VCO
2), measured energy expenditure (MEE), and total urinary nitrogen (TUN) were measured serially in seven infants (average age, 78 days) during the first 72 hours after abdominal or thoracic surgery. Nonprotein respiratory quotient (RQ
np), and values for oxidation of carbohydrate (C
e) and fat (F
e) were calculated. Injury severity was stratified based on serum CRP concentrations of ≥6.0 mg/dL (high stress) or 1.0) was significantly less likely in the resolving (
2
6
studies, 33.4%) versus acute stress (
9
13
studies, 69.2%, Z test
P < .001) group. Five of seven (
5
7
) patients (
9
19
individual studies) had negative F
e values (average −9.89 ± 10.02) reflecting net lipogenesis. The RQ
np for these nine studies was 1.14 ± 0.11 versus 0.97 ± 0.09 for the remaining 10, and this difference was significant (
P < .01). A significant correlation existed between carbohydrate intake and VCO
2 (Pearson
r = .6951,
P < .01). In addition, t |
| doi_str_mv | 10.1016/0022-3468(95)90327-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_77674673</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>0022346895903275</els_id><sourcerecordid>77674673</sourcerecordid><originalsourceid>FETCH-LOGICAL-c423t-cfb6eb759e75f1b3ddd51eba615249e3bfae43d2bf2e25317a9e5507badb9b363</originalsourceid><addsrcrecordid>eNp9kE1LAzEQhoMotVb_gcKeRA-r-dhszEWQUj-g4MWeQ7I7qdHtZk12C_33ph94FAZmmHnnHeZB6JLgO4JJeY8xpTkryocbyW8lZlTk_AiNCWck55iJYzT-k5yisxi_ME5tTEZoJApBJZdjtJjp0GyyzsfedxB079aQ6abflb6NmWtTWN32GbQQlptsiJA6VQCdiv4TsuDid-Zt5tcQLEDt2uU5OrG6iXBxyBO0eJ59TF_z-fvL2_RpnlcFZX1eWVOCEVyC4JYYVtc1J2B0STgtJDBjNRSspsZSoOktoSVwjoXRtZGGlWyCrve-XfA_A8RerVysoGl0C36ISohSFKVgSVjshVXwMQawqgtupcNGEay2NNUWldqiUpKrHU3F09rVwX8wK6j_lg740vxxP4f05NpBULFy0FYJQoCqV7V3_x_4BQ0shbE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>77674673</pqid></control><display><type>article</type><title>Early postoperative alterations in infant energy use increase the risk of overfeeding</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Letton, Robert W ; Chwals, Walter J ; Jamie, Angela ; Charles, Barbara</creator><creatorcontrib>Letton, Robert W ; Chwals, Walter J ; Jamie, Angela ; Charles, Barbara</creatorcontrib><description>Aim of Study: Energy needs in infants are decreased after surgery because of growth inhibition (resulting from catabolic stress metabolism), decreased insensible losses, and inactivity. Using standardized formulas that account for growth, activity, and insensible losses during this stress period can lead to overfeeding in excess of 200% of the actual measured requirement. Overfeeding during this acute injury period can result in increased CO
2 production from lipogenesis. This study determined the effects of a reduced rate of mixed caloric repletion on infant energy use during the early postoperative period.
Methods: C-reactive protein (CRP), oxygen consumption (VO
2), carbon dioxide production (VCO
2), measured energy expenditure (MEE), and total urinary nitrogen (TUN) were measured serially in seven infants (average age, 78 days) during the first 72 hours after abdominal or thoracic surgery. Nonprotein respiratory quotient (RQ
np), and values for oxidation of carbohydrate (C
e) and fat (F
e) were calculated. Injury severity was stratified based on serum CRP concentrations of ≥6.0 mg/dL (high stress) or <6.0 mg/dL (low stress). Recovery from acute stress was analyzed by comparing studies in which CRP had decreased to ≤2.0 mg/dL (resolving stress group) with those in which CRP values were greater than 2.0 mg/dL (acute stress group).
Results: Average total caloric intake (64.56 ± 18.51 kcal/kg/d; approximately 50% of predicted energy requirement) exceeded average MEE (42.90 ± 9.98 kcal/kg/d) by approximately 50%. Average TUN was 0.18 ± 0.07 g/kg/d (high stress 0.2 ± 0.05 versus low stress 0.16 ± 0.09 g/kg/d). Average RQ
np was 1.05 ± 0.13 and average C
e was 37.28 ± 16.86 kcal/kg/d. The average calculated F
e was 0.0 ± 12.27 kcal/kg/d, reflecting approximately equal amounts of fat oxidized compared with fat generated from excess glucose (lipogenesis). When individual studies were analyzed at a CRP cutpoint of 2.0 mg/dL, overfeeding (RQ > 1.0) was significantly less likely in the resolving (
2
6
studies, 33.4%) versus acute stress (
9
13
studies, 69.2%, Z test
P < .001) group. Five of seven (
5
7
) patients (
9
19
individual studies) had negative F
e values (average −9.89 ± 10.02) reflecting net lipogenesis. The RQ
np for these nine studies was 1.14 ± 0.11 versus 0.97 ± 0.09 for the remaining 10, and this difference was significant (
P < .01). A significant correlation existed between carbohydrate intake and VCO
2 (Pearson
r = .6951,
P < .01). In addition, there was a good correlation between carbohydrate intake and VCO
2 (Pearson
r = .6591,
P < .01). The coefficient of variation for MEE was 8.0% (low stress) versus 30.2% (high stress).
Conclusion: Lipogenesis with increased CO
2 production is substantial, even at reduced caloric delivery rates that exceeded MEE by only 50%, during the early postoperative acute metabolic stress period in infants. These data suggest that caloric requirements during stress are likely equal to or only minimally in excess of actual MEE. Intersubject variability, especially in more severely stressed infants, underscores the importance of serial measurements of energy expenditure to enable precise caloric delivery and avoid overfeeding. In the absence of calorimetric measurement, the data suggest that PBMR (predicted basal metabolic rate) should be used to estimate caloric delivery until CRP values are ≤2.0 mg/dL.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/0022-3468(95)90327-5</identifier><identifier>PMID: 7472959</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen - surgery ; C-Reactive Protein - analysis ; Carbon Dioxide - metabolism ; Dietary Carbohydrates - metabolism ; Dietary Fats - metabolism ; Energy Intake ; Energy Metabolism ; Glucose - metabolism ; Growth ; Humans ; Infant ; Infant Food ; Infant Nutritional Physiological Phenomena ; Lipids - biosynthesis ; Motor Activity ; Nitrogen - urine ; Oxidation-Reduction ; Oxygen Consumption ; Postoperative Period ; Respiration ; Risk Factors ; Stress, Physiological - metabolism ; Surgical Procedures, Operative ; Thoracic Surgery</subject><ispartof>Journal of pediatric surgery, 1995-07, Vol.30 (7), p.988-993</ispartof><rights>1995</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-cfb6eb759e75f1b3ddd51eba615249e3bfae43d2bf2e25317a9e5507badb9b363</citedby><cites>FETCH-LOGICAL-c423t-cfb6eb759e75f1b3ddd51eba615249e3bfae43d2bf2e25317a9e5507badb9b363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0022-3468(95)90327-5$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7472959$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Letton, Robert W</creatorcontrib><creatorcontrib>Chwals, Walter J</creatorcontrib><creatorcontrib>Jamie, Angela</creatorcontrib><creatorcontrib>Charles, Barbara</creatorcontrib><title>Early postoperative alterations in infant energy use increase the risk of overfeeding</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Aim of Study: Energy needs in infants are decreased after surgery because of growth inhibition (resulting from catabolic stress metabolism), decreased insensible losses, and inactivity. Using standardized formulas that account for growth, activity, and insensible losses during this stress period can lead to overfeeding in excess of 200% of the actual measured requirement. Overfeeding during this acute injury period can result in increased CO
2 production from lipogenesis. This study determined the effects of a reduced rate of mixed caloric repletion on infant energy use during the early postoperative period.
Methods: C-reactive protein (CRP), oxygen consumption (VO
2), carbon dioxide production (VCO
2), measured energy expenditure (MEE), and total urinary nitrogen (TUN) were measured serially in seven infants (average age, 78 days) during the first 72 hours after abdominal or thoracic surgery. Nonprotein respiratory quotient (RQ
np), and values for oxidation of carbohydrate (C
e) and fat (F
e) were calculated. Injury severity was stratified based on serum CRP concentrations of ≥6.0 mg/dL (high stress) or <6.0 mg/dL (low stress). Recovery from acute stress was analyzed by comparing studies in which CRP had decreased to ≤2.0 mg/dL (resolving stress group) with those in which CRP values were greater than 2.0 mg/dL (acute stress group).
Results: Average total caloric intake (64.56 ± 18.51 kcal/kg/d; approximately 50% of predicted energy requirement) exceeded average MEE (42.90 ± 9.98 kcal/kg/d) by approximately 50%. Average TUN was 0.18 ± 0.07 g/kg/d (high stress 0.2 ± 0.05 versus low stress 0.16 ± 0.09 g/kg/d). Average RQ
np was 1.05 ± 0.13 and average C
e was 37.28 ± 16.86 kcal/kg/d. The average calculated F
e was 0.0 ± 12.27 kcal/kg/d, reflecting approximately equal amounts of fat oxidized compared with fat generated from excess glucose (lipogenesis). When individual studies were analyzed at a CRP cutpoint of 2.0 mg/dL, overfeeding (RQ > 1.0) was significantly less likely in the resolving (
2
6
studies, 33.4%) versus acute stress (
9
13
studies, 69.2%, Z test
P < .001) group. Five of seven (
5
7
) patients (
9
19
individual studies) had negative F
e values (average −9.89 ± 10.02) reflecting net lipogenesis. The RQ
np for these nine studies was 1.14 ± 0.11 versus 0.97 ± 0.09 for the remaining 10, and this difference was significant (
P < .01). A significant correlation existed between carbohydrate intake and VCO
2 (Pearson
r = .6951,
P < .01). In addition, there was a good correlation between carbohydrate intake and VCO
2 (Pearson
r = .6591,
P < .01). The coefficient of variation for MEE was 8.0% (low stress) versus 30.2% (high stress).
Conclusion: Lipogenesis with increased CO
2 production is substantial, even at reduced caloric delivery rates that exceeded MEE by only 50%, during the early postoperative acute metabolic stress period in infants. These data suggest that caloric requirements during stress are likely equal to or only minimally in excess of actual MEE. Intersubject variability, especially in more severely stressed infants, underscores the importance of serial measurements of energy expenditure to enable precise caloric delivery and avoid overfeeding. In the absence of calorimetric measurement, the data suggest that PBMR (predicted basal metabolic rate) should be used to estimate caloric delivery until CRP values are ≤2.0 mg/dL.</description><subject>Abdomen - surgery</subject><subject>C-Reactive Protein - analysis</subject><subject>Carbon Dioxide - metabolism</subject><subject>Dietary Carbohydrates - metabolism</subject><subject>Dietary Fats - metabolism</subject><subject>Energy Intake</subject><subject>Energy Metabolism</subject><subject>Glucose - metabolism</subject><subject>Growth</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant Food</subject><subject>Infant Nutritional Physiological Phenomena</subject><subject>Lipids - biosynthesis</subject><subject>Motor Activity</subject><subject>Nitrogen - urine</subject><subject>Oxidation-Reduction</subject><subject>Oxygen Consumption</subject><subject>Postoperative Period</subject><subject>Respiration</subject><subject>Risk Factors</subject><subject>Stress, Physiological - metabolism</subject><subject>Surgical Procedures, Operative</subject><subject>Thoracic Surgery</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LAzEQhoMotVb_gcKeRA-r-dhszEWQUj-g4MWeQ7I7qdHtZk12C_33ph94FAZmmHnnHeZB6JLgO4JJeY8xpTkryocbyW8lZlTk_AiNCWck55iJYzT-k5yisxi_ME5tTEZoJApBJZdjtJjp0GyyzsfedxB079aQ6abflb6NmWtTWN32GbQQlptsiJA6VQCdiv4TsuDid-Zt5tcQLEDt2uU5OrG6iXBxyBO0eJ59TF_z-fvL2_RpnlcFZX1eWVOCEVyC4JYYVtc1J2B0STgtJDBjNRSspsZSoOktoSVwjoXRtZGGlWyCrve-XfA_A8RerVysoGl0C36ISohSFKVgSVjshVXwMQawqgtupcNGEay2NNUWldqiUpKrHU3F09rVwX8wK6j_lg740vxxP4f05NpBULFy0FYJQoCqV7V3_x_4BQ0shbE</recordid><startdate>19950701</startdate><enddate>19950701</enddate><creator>Letton, Robert W</creator><creator>Chwals, Walter J</creator><creator>Jamie, Angela</creator><creator>Charles, Barbara</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19950701</creationdate><title>Early postoperative alterations in infant energy use increase the risk of overfeeding</title><author>Letton, Robert W ; Chwals, Walter J ; Jamie, Angela ; Charles, Barbara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-cfb6eb759e75f1b3ddd51eba615249e3bfae43d2bf2e25317a9e5507badb9b363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Abdomen - surgery</topic><topic>C-Reactive Protein - analysis</topic><topic>Carbon Dioxide - metabolism</topic><topic>Dietary Carbohydrates - metabolism</topic><topic>Dietary Fats - metabolism</topic><topic>Energy Intake</topic><topic>Energy Metabolism</topic><topic>Glucose - metabolism</topic><topic>Growth</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant Food</topic><topic>Infant Nutritional Physiological Phenomena</topic><topic>Lipids - biosynthesis</topic><topic>Motor Activity</topic><topic>Nitrogen - urine</topic><topic>Oxidation-Reduction</topic><topic>Oxygen Consumption</topic><topic>Postoperative Period</topic><topic>Respiration</topic><topic>Risk Factors</topic><topic>Stress, Physiological - metabolism</topic><topic>Surgical Procedures, Operative</topic><topic>Thoracic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Letton, Robert W</creatorcontrib><creatorcontrib>Chwals, Walter J</creatorcontrib><creatorcontrib>Jamie, Angela</creatorcontrib><creatorcontrib>Charles, Barbara</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Letton, Robert W</au><au>Chwals, Walter J</au><au>Jamie, Angela</au><au>Charles, Barbara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early postoperative alterations in infant energy use increase the risk of overfeeding</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>1995-07-01</date><risdate>1995</risdate><volume>30</volume><issue>7</issue><spage>988</spage><epage>993</epage><pages>988-993</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>Aim of Study: Energy needs in infants are decreased after surgery because of growth inhibition (resulting from catabolic stress metabolism), decreased insensible losses, and inactivity. Using standardized formulas that account for growth, activity, and insensible losses during this stress period can lead to overfeeding in excess of 200% of the actual measured requirement. Overfeeding during this acute injury period can result in increased CO
2 production from lipogenesis. This study determined the effects of a reduced rate of mixed caloric repletion on infant energy use during the early postoperative period.
Methods: C-reactive protein (CRP), oxygen consumption (VO
2), carbon dioxide production (VCO
2), measured energy expenditure (MEE), and total urinary nitrogen (TUN) were measured serially in seven infants (average age, 78 days) during the first 72 hours after abdominal or thoracic surgery. Nonprotein respiratory quotient (RQ
np), and values for oxidation of carbohydrate (C
e) and fat (F
e) were calculated. Injury severity was stratified based on serum CRP concentrations of ≥6.0 mg/dL (high stress) or <6.0 mg/dL (low stress). Recovery from acute stress was analyzed by comparing studies in which CRP had decreased to ≤2.0 mg/dL (resolving stress group) with those in which CRP values were greater than 2.0 mg/dL (acute stress group).
Results: Average total caloric intake (64.56 ± 18.51 kcal/kg/d; approximately 50% of predicted energy requirement) exceeded average MEE (42.90 ± 9.98 kcal/kg/d) by approximately 50%. Average TUN was 0.18 ± 0.07 g/kg/d (high stress 0.2 ± 0.05 versus low stress 0.16 ± 0.09 g/kg/d). Average RQ
np was 1.05 ± 0.13 and average C
e was 37.28 ± 16.86 kcal/kg/d. The average calculated F
e was 0.0 ± 12.27 kcal/kg/d, reflecting approximately equal amounts of fat oxidized compared with fat generated from excess glucose (lipogenesis). When individual studies were analyzed at a CRP cutpoint of 2.0 mg/dL, overfeeding (RQ > 1.0) was significantly less likely in the resolving (
2
6
studies, 33.4%) versus acute stress (
9
13
studies, 69.2%, Z test
P < .001) group. Five of seven (
5
7
) patients (
9
19
individual studies) had negative F
e values (average −9.89 ± 10.02) reflecting net lipogenesis. The RQ
np for these nine studies was 1.14 ± 0.11 versus 0.97 ± 0.09 for the remaining 10, and this difference was significant (
P < .01). A significant correlation existed between carbohydrate intake and VCO
2 (Pearson
r = .6951,
P < .01). In addition, there was a good correlation between carbohydrate intake and VCO
2 (Pearson
r = .6591,
P < .01). The coefficient of variation for MEE was 8.0% (low stress) versus 30.2% (high stress).
Conclusion: Lipogenesis with increased CO
2 production is substantial, even at reduced caloric delivery rates that exceeded MEE by only 50%, during the early postoperative acute metabolic stress period in infants. These data suggest that caloric requirements during stress are likely equal to or only minimally in excess of actual MEE. Intersubject variability, especially in more severely stressed infants, underscores the importance of serial measurements of energy expenditure to enable precise caloric delivery and avoid overfeeding. In the absence of calorimetric measurement, the data suggest that PBMR (predicted basal metabolic rate) should be used to estimate caloric delivery until CRP values are ≤2.0 mg/dL.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>7472959</pmid><doi>10.1016/0022-3468(95)90327-5</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-3468 |
| ispartof | Journal of pediatric surgery, 1995-07, Vol.30 (7), p.988-993 |
| issn | 0022-3468 1531-5037 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_77674673 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Abdomen - surgery C-Reactive Protein - analysis Carbon Dioxide - metabolism Dietary Carbohydrates - metabolism Dietary Fats - metabolism Energy Intake Energy Metabolism Glucose - metabolism Growth Humans Infant Infant Food Infant Nutritional Physiological Phenomena Lipids - biosynthesis Motor Activity Nitrogen - urine Oxidation-Reduction Oxygen Consumption Postoperative Period Respiration Risk Factors Stress, Physiological - metabolism Surgical Procedures, Operative Thoracic Surgery |
| title | Early postoperative alterations in infant energy use increase the risk of overfeeding |
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