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Allan, Kirstie, Grimble, George, Perry, Laura and Illingworth, Sarah (2025) Development of a pilot equation using mid-upper-arm circumference for estimating energy requirements in place of weight-based equations. Clinical Nutrition ESPEN, 68. pp. 870-871. ISSN 2405-4577
Background:
Measurement of height and body weight in critical illness remains challenging however despite this, the use of prediction equations to assess energy expenditure are based on body weight. Mid upper arm circumference (MUAC) has been determined as a good marker of nutritional status and can identify deteriorations over time (1,2). The need for the development of non-weight based equations in this population is evident. MUAC may be easier to obtain in a critical care setting where weight measurements may not be possible and be unreliable (3).
Aims:
This study aimed to conduct preliminary analysis of a pilot equation created using mid-upper-arm-circumference (MUAC) in conjunction with measured total energy expenditure (TEE) from indirect calorimetry (IC) measurements.
Methods:
Forward regression was performed using IC with added Physical Activity Level (PAL) factor and MUAC measurements to create pilot equation for this population group predicting energy expenditure across three stages of their hospital stay; pre-operative, post-operative and rehabilitation. Following achievement of equation, Bland Altman plots determined the level of agreement between measured TEE (from IC), predicted TEE (from pilot equation) and TEE from validated prediction equations (Mifflin St. Jeor (MSJ), ESPEN 22.5kcal/kg, ESPEN 27.5kcal/kg and ESPEN ventilated) to determine the potential for this equation to be considered for validation.
Results:
A significant regression equation was found for the rehabilitation stage only (F(1,7) = 6.123, p =0.043, with r2 = 0.467), measured TEE increased by 64.360kcal for each cm of MUAC and found to be a significant predictor of TEE (1 –β =0.67). The pilot equation showed higher accuracy in calculating TEE when compared to MSJ and ESPEN 27.5kcal and lower degree of overestimation of TEE than MSJ and ESPEN 27.5kcal/kg.
Conclusions:
The need for a non-weight based alternative to measuring energy requirements is clear, with the solution to this potentially including the use of this pilot equation discovered using MUAC. However, a larger study is required with minimum 26 participants in line with power calculation including diverse population to assess the suitability of a non-weight based predictor of TEE in patients within critical care.
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