老年住院人群的静息热量预测公式:间接测热法与13种公式预测法的一致性研究  

A formula to predict the resting energy expenditure of hospitalized older adults:a consistency study between the indirect calorimetry measurement and 13 formulas

作　　者：张瑞英 赵岩妍 倪琛琛 侯平 范丽丽[5] 董明 张黎[7] 赵春梅 吴聪[9] 周起 武文斌[11] Zhang Ruiying;Zhao Yanyan;Ni Chenchen;Hou Ping;Fan Lili;Dong Ming;Zhang Li;Zhao Chunmei;Wu Cong;Zhou Qi;Wu Wenbin(Hengshui People's Hospital,Hengshui 053000,China;Department of Geriatrics,Beijing Youlian Hospital,Beijing 100023,China;Department of Geriatrics,Hefei First People's Hospital,Hefei 230061,China;Department of Geriatrics,Xing Anmeng Hospital,Wulanhaote 137499,China;Department of Geriatrics,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,China;Department of Geriatrics,Panjin Liaoyou Gemstone Flower Hospital,Panjin 124009,China;Department of Geriatrics,First People's Hospital of Yunnan Province,Kunming 650034,China;Department of Geriatrics,Shandong Provincial Taishan Hospital,Taian 271099,China;Geriatric Endocrinology Department,the First Affiliated Hospital of Zhengzhou,Zhengzhou 450052,China;The Key Laboratory of Geriatrics,Beijing Institute of Geriatrics,Beijing Hospital,National Center of Gerontology,National Health Commission,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Geriatrics,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]衡水市人民医院肾内科,衡水053000 [2]北京优联医院老年科,北京100023 [3]合肥市第一人民医院老年科,合肥230061 [4]兴安盟人民医院老年医学科,乌兰浩特137499 [5]深圳市中医院老年医学科,深圳518033 [6]盘锦辽油宝石花医院老年病科,盘锦124009 [7]云南省第一人民医院老年科,昆明650034 [8]山东省泰山医院老年医学科,泰安271099 [9]郑州大学第一附属医院老年内分泌科,郑州450052 [10]北京医院、国家老年医学中心、国家卫生健康委北京老年医学研究所、国家卫生健康委老年医学重点实验室、中国医学科学院老年医学研究院,北京100730 [11]北京医院老年科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2024年第12期1581-1586,共6页Chinese Journal of Geriatrics

基　　金：中央高水平医院临床科研业务费(BJ-2022-181)。

摘　　要：目的探讨既往静息热量(REE)预测公式的准确性,并开发一款适合住院老年人的REE预测公式。方法基于横断面数据的一致性研究,纳入2022年10月1日至2023年11月31日于北京医院老年医学科住院的老年人,通过性别、年龄、体质指数(BMI)、血压等和静息热量相关的参数,计算Harris-Benedict等13种老年人常用公式静息热量预测值(pREE)。以间接测热法测量值(mREE)为金标准,并比较各pREE和mREE的组间差异,计算组内相关系数(ICC)以及准确率(以±10%mREE值为参考)。利用十折交叉验证方法筛选有效变量,构建新预测公式,并比较其和金标准、Harris-Benedict、欧洲肠外肠内营养学会(ESPEN)以及中国肠外肠内营养学会(CSPEN)推荐公式的性能。结果共纳入223例住院老年人,年龄60~98(79.5±8.2)岁,男性占49.3%(110例),衰弱老年人比例约84.3%(188例)。14个公式预测的pREE和金标准mREE结果差异较大(中位差值9.1~232.1 kcal/d)。Harris-Benedict、DESPEN、CSPEN预测值和mREE的差异有统计学意义(均P<0.05),准确率仅分别为30.9%、31.4%及24.7%。新开发公式为:pREE=794.847+8.661×体重-7.976×年龄+14.757×握力+5.037×心率,ICC(95%CI)系数为0.6(0.5~0.7),准确率为56.3%。结论常见公式在住院老年人中预测REE的性能较差,新开发的公式性能优于既往公式,可作为该人群预测静息热量的参考方法。ObjectiveTo investigate the accuracy of resting energy expenditure(REE)prediction formulas and to develop a new REE prediction formula suitable for hospitalized older adults.MethodsOlder adults hospitalized in the Department of Geriatrics from October 1,2022,to November 31,2022,were included in the study.The predicted values of REE(pREE)were estimated using 13 commonly employed formulas that incorporate parameters related to resting energy expenditure,such as gender,age,body mass index(BMI),and body weight.Indirect calorimetry measurements(mREE)served as the gold standard for comparison.Group differences between pREE and mREE,the coefficient of concordance(ICC),and accuracy(defined as±10%of the mREE values)were utilized to evaluate the performance of the formulas.The ten-fold cross-validation method was employed to identify valid variables and to construct a new prediction formula.The performance of this new formula was compared to mREE,the Harris-Benedict formula,the European Society of Clinical Nutrition and Metabolism(ESPEN)formula,and the Chinese Society of Clinical Nutrition and Metabolism(CSPEN)formula.ResultsA total of 223 hospitalized participants aged 60 to 98 years(mean age 79.5±8.2 years)were included in the study.Among these participants,49.3%(110 cases)were male,and the prevalence of frailty was approximately 84.3%(188 cases).The median difference between pREE and mREE ranged from 9.1 to 232.1 kcal/d.The predictions from the Harris-Benedict,ESPEN,and CSPEN equations differed significantly from mREE(all P<0.05),with respective accuracies of 30.9%,31.4%,and 24.7%.A new equation was developed:pREE=794.847+8.661×body weight-7.976×age+14.757×grip strength+5.037×heart rate,with an ICC of 0.6(95%CI:0.5-0.7),and the accuracy reached 56.3%.ConclusionsExisting equations demonstrate low accuracy in predicting REE among hospitalized older adults.The newly developed equation shows improved performance compared to previous models and can serve as a reference method for predicting REE in this demographic.

关 键 词：住院患者 静息热量 间接测热法 预测静息热量 

分 类 号：R592[医药卫生—老年医学]