FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Energy expenditure and balance in pressure ulcer patients: a systematic review
and meta-analysis of observational studies
Emanuele Cereda 1* , Catherine Klersy 2 , Mariangela Rondanelli, 3 Riccardo Caccialanza 1
1* Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,
e.cereda@smatteo.pv.it
2 Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
3 Ambulatorio di Dietologia, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione
di Nutrizione, Azienda di Servizi alla Persona di Pavia, Università degli Studi di Pavia, Pavia, Italy
Introduction
Nutritional treatment is reported to contribute to wound
healing [1,2] and current guidelines recommend
prescribing an energy intake of 30-35 Kcal/kg/day.
However, such advice is based on expert consensus,
rather than rigorous methodological approach.
Moreover, the effectiveness of interventions requires
an accurate estimation of individual energy needs
which in turn rely on accurate methods of assessment.
The primary aims of this systematic review and metaanalysis
were to evaluate 1) the resting energy
expenditure (REE) of pressure ulcer (PU) patients
compared to matched controls and 2) the potential
estimation bias of REE predictive equations and 3) to
estimate the recommendable daily requirements in
PUs. The energy balance of PU patients (daily energy
requirements vs calorie intake) was also considered.
Methods
All-language original full-text research articles,
published between 1 January 1950 and 31 July 2010
were searched through electronic databases. Relevant
studies were also identified by citations reviewing.
Only studies providing data on measured REE were
initially included. Data extracted were: measured REE,
predicted REE and daily calorie intake.
Fig. 1: Flow diagram of systematic review of literature.
88
Results
Five studies were included in the meta-analysis. PU
patients (n=92) presented higher measured REE than
controls (n=101) and predicted REE (by Harris-
Benedict formula in all the studies). In PU patients
(n=78) energy intake was also significantly lower than
total daily requirements that it were computed being
29.9±2.8 kcal/kg/day (median, 30.6 [25th-75th
percentile, 26.1-32.5]).
Discussion
PU patients are characterized by increased REE. In
the estimation of REE by Harris-Benedict formula a
correction factor (x 1.1) should be considered. A
calorie intake of 30 Kcal/kg/day seems appropriate to
cover daily requirements. The monitoring of energy
intake in such patients is recommended also toward
the potential necessity to plan guideline-based
nutritional interventions.
Clinical relevance
As suggested by current international guidelines a
calorie intake of 30 Kcal/kg/day seems appropriate to
cover the daily requirements of PU patients. Given the
positive effect of nutritional support on the healing
process, the monitoring of energy intake and the timely
planning of appropriate guideline-based nutritional
interventions to cover energy needs is advisable.
Acknowledgements
We wish to thank Professor Patrick Ritz (Toulouse
University Hospital, France) for kindly providing us all
the original data necessary to complete the study.
Funding: The study was supported by the Fondazione
IRCCS Policlinico San Matteo and by an Investigator
Grant from Nutricia (to EC).
Conflict of Interest
None to be reported
References
[1] Cereda. et al., J. Am. Geriatr. Soc. 57:1395-402,
2009
[2] National Pressure Ulcer Advisory Panel (NPUAP)
and European Pressure Ulcer Advisory Panel
(EPUAP). Prevention and treatment of pressure
ulcers: clinical practice guideline. Washington, DC:
National Pressure Ulcer Advisory Panel; 2009
Copyright © 2010 by EPUAP