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PubMed1996

Why health care costs more in the US: comparing health care expenditures between systemic lupus erythematosus patients in Stanford and Montreal.

OBJECTIVE: Recent studies to identify the causes of higher health care expenditure in the US versus Canada have relied on population-based measures of health care utilization and have restricted their analysis to one sector, such as physician or hospital expenditures. We present a detailed comparative analysis of the direct costs (health services utilized) of treating systemic lupus erythematosus (SLE) patients in Stanford, CA and Montreal, Quebec. METHODS: Using the self-report Stanford Health Assessment Questionnaire, we assessed 6-month direct costs incurred by 174 American and 164 Canadian SLE patients. We explored 3 potential reasons for the differential expenditure. These were 1) higher prices for health care inputs, 2) more severe disease in the patient case mix, and 3) greater resource utilization. RESULTS: The direct health care costs for the American SLE patients exceeded those for the Canadian patients by almost 2-fold ($10,530 versus $5,271, expressed in 1991 US dollars). The higher direct costs were explained by the higher price of health services in the US and the more severe disease mix. In fact, for all health resources categories studies, Canadians utilized at least as many services as their American counterparts. Canadians had longer hospital stays, made more emergency room visits, and used more medications. CONCLUSION: Despite significantly greater per capita health care expenditure in the US, our data show that Canadian SLE patients actually receive more medical services.

California↗
PubMed1995

Energy expenditure in lean and obese prepubertal children.

The relationship between energy expenditure and obesity was examined in prepubertal children. Consenting fifth graders underwent Tanner Staging, weight, height and skinfold measurements. Subjects were selected for further study to obtain equal numbers of girls and boys with a wide range of body composition. Weight, total daily energy expenditure (TDEE) by doubly labeled water (DLW), resting metabolic rate (RMR), and body composition were measured. Children were grouped into level of obesity based on tertiles of subscapular plus triceps skinfolds. The skinfold tertiles did quite well in grouping subjects by degree of obesity, as differences in percent fat in each tertile were significantly different. There were no differences in fat-free mass between the groups, while the highest tertile group weighed 14 kg more than the lowest. For DLW, energy expenditure was calculated using day 8 and day 9 urine samples as the final time point to examine precision. Mean energy expenditure using either day was nearly identical (2220 +/- 400 vs 2300 +/- 370 kcal/d), with a CV of the difference of 5.5%. No differences in RMR, energy expended in activity, or TDEE between the three groups were observed. A reduction in RMR or TDEE could not explain differences in obesity in these prepubertal children. However, the fact that the heaviest children expended the same amount of energy in activity and had the same TDEE as the leanest, while weighing 14 kg more, indicates that the obese children had a reduced activity level.

Absorptiometry, Photon↗
PubMed2002

Energy expenditure and testosterone in free-living male yellow-pine chipmunks.

The onset of mating in yellow-pine chipmunks (Tamias amoenus) follows emergence from a prolonged period of energy conservation during hibernation. Energy expenditures are greatly accelerated to meet the demands of the reproductive season. When emerging from hibernation, typical male chipmunks (breeders) have enlarged testes and a high level of plasma testosterone (T). However, certain males that do not participate in reproduction (nonbreeders) maintain small testes and low plasma T levels and emerge several weeks later than the breeders. The timing of the terminal arousal from hibernation and onset of mating are associated with increased plasma T levels. Experimental elevation of T levels in T. amoenus outside the mating season has been associated with a decrease in body mass, further suggesting an effect of T on energy balance. To test this hypothesis, we measured daily energy expenditure (DEE) in free-living, nonbreeding male chipmunks in the presence and absence of a T-implant. We also measured DEE in breeding males when endogenous T levels were high. DEE of the nonbreeders was not affected by our manipulation of plasma T, and the DEE of breeding males did not differ from that of nonbreeders. We conclude that energy expenditure on a daily basis in male yellow-pine chipmunks is not influenced by levels of T. However, on a seasonal basis, the earlier emergence from hibernation by breeding males, which appears to be influenced by T, represents an overall seasonal energy expenditure that exceeds that of nonbreeding males.

Animals↗
PubMed1983

Energy expenditure and whole body protein synthesis in very low birth weight (VLBW) infants.

To examine the rates of whole body protein synthesis and energy expenditure during the rapid growing period, premature infants of very low birth weight (VLBW) (less than 1500 g), appropriate for gestational age were kept under standard thermoneutrality conditions and received a formula diet providing 110 kcal/kg.d metabolisable energy (ME) and 3.3 g protein/kg.d. Their energy expenditure was measured by open circuit indirect calorimetry. Nitrogen turnover and whole body protein synthesis and catabolism were determined using repeated oral administration of 15N-glycine for 60-72 h followed by the analysis of 15N-enrichment in urinary urea. These VLBW infants grew at an average rate of 15 g/kg.d. About half of the ME intake (i.e. 50 kcal/kg.d) was invested in weight gain while the remainder (i.e. 60 kcal/kg.d) was oxidised. The energy equivalent of the weight gain (i.e. the amount of energy stored per g weight gain) and the N balance indicated that lean tissue made up approximately 2/3 of the weight gained and fat tissue the remaining 1/3. The plateau value for 15N enrichment reached on the third day of administration allowed us to calculate a rate of protein synthesis of 14 g/kg.d and protein breakdown of 12 g/kg.d in five VLBW fed a formula diet. The elevated energy expenditure of the very low birth weight infant seems to be related to its rapid rate of weight gain which is accompanied by a high rate of body protein synthesis. More than 20% of the total energy expenditure of the VLBW infants was accounted for by whole body protein synthesis.

Energy Metabolism↗
PubMed1997

Assessment of energy expenditure in metabolic disorders.

The assessment of energy expenditure is valuable for the management of children with various conditions such as obesity and failure to thrive. Total daily energy expenditure (TDEE) includes resting energy expenditure (REE), energy expenditure during physical activity, dietary thermogenesis and growth. TDEE can be assessed by using the double-labelled water technique, but it has complex pitfalls and potential sources of errors and is impractical for everyday use. As REE is a substantial part of TDEE (65%-70%) and computerised indirect calorimeters have become recently available, this non-invasive, relatively cheap and easy to use technique is valuable for the assessment of short-term changes in energy metabolism. This can be used to assess REE of children with inborn errors of metabolism, whilst well and during episodes of metabolic decompensation and therefore to accurately determine energy intake.

Calorimetry, Indirect↗
PubMed1998

Maternal diabetes status does not influence energy expenditure or physical activity in 5-year-old Pima Indian children.

Children of women who have diabetes during pregnancy are more likely to become obese by early adulthood than those of women with normal glucose tolerance during pregnancy. Obesity can result from either excess food intake, low levels of energy expenditure or both. In our study, we tested whether maternal diabetes status influences total energy expenditure (TEE by doubly labelled water), resting metabolic rate (RMR by ventilated hood) and physical activity level (PAL = TEE/RMR and assessed by activity questionnaire). Measurements were taken in 88 5-year-old Pima Indian children, 24 children of women with diabetes (2-h plasma glucose > or = 11.1 mmol/l) diagnosed before or during pregnancy and 64 children of women with normal glucose tolerance (2-h plasma glucose < 7.8 mmol/l during pregnancy and no prior history of abnormal glucose tolerance). Although birth weight was higher in children of diabetic than of nondiabetic women (mean +/- SD; 3.8 +/- 0.6 vs 3.5 +/- 0.4 kg, p < 0.03), there were no differences in weight (26.4 +/- 6.9 vs 24.2 +/- 5.6 kg) or per cent body fat (18O dilution; 33 +/- 8 vs 31 +/- 8%) between the groups at 5 years of age. There was no difference in TEE (6508 +/- 1109 vs 6175 +/- 942 kJ/d) or in RMR (4674 +/- 786 vs 4483 +/- 603 kJ/d) expressed as absolute values or after adjustment for weight and sex (TEE) or fat-free mass, fat mass, and sex (RMR). Physical activity level was also similar between the groups (1.40 +/- 0.12 vs 1.38 +/- 0.12). These results suggest that maternal diabetes status does not influence energy expenditure in the children by 5 years of age. Thus the greater obesity seen at older ages in the children of women with diabetes could be due to excess energy intake. Alternatively, if energy expenditure does have a role in the aetiology of obesity in these children, perhaps it does so only in older children.

Basal Metabolism↗
PubMed2005

Impact of regulatory changes on first- and second-generation antipsychotic drug consumption and expenditure in Italy.

BACKGROUND: In 1994 a change in drug reimbursement status was implemented in Italy according to cost-effectiveness criteria. The aim of this study was to examine the impact of these changes on the use of antipsychotic (AP) drugs. METHODS: Data concerning actual quantities of antipsychotic agents dispensed in Italy from 1995 to June 2003 were obtained from the Italian Ministry of Health. For each antipsychotic agent, the number of defined daily doses (DDDs) per 1,000 inhabitants per day was calculated, as well as the annual expenditure in Euros. RESULTS: From 1995 to June 2003 prescriptions for first-generation antipsychotic agents (FGAs) progressively decreased from 2.54 to 2.0 DDD/1,000/day; in contrast, prescriptions for second-generation antipsychotic agents (SGAs) progressively rose up to 1.75 DDD/1,000/day in 2003. Overall, from 1995 to 2003 antipsychotic prescriptions rose from 2.54 to 3.75 DDD/1,000/day. In 2003 the antipsychotic drug most frequently used was haloperidol, followed by olanzapine and risperidone. In 2003 the use of SGAs accounted for nearly 50% of overall DDD/1,000/day of AP agents. The cost of these new drugs, however, accounted for more than 80% of the total AP expenditure. CONCLUSIONS: In Italy, the progressive increase in the utilisation of SGAs has been accompanied by a moderate decrease in the utilisation of phenothiazines and by an almost constant use of butyrophenones. The policy of reimbursing the use of SGAs only in subjects who could not tolerate FGAs eventually failed to significantly affect the pattern of antipsychotic consumption and expenditure; moreover, when this policy was eliminated at the beginning of 2001, the pattern of consumption and expenditure did not change.

Antipsychotic Agents↗
PubMed2003

Energy expenditure in ischemic stroke patients treated with moderate hypothermia.

OBJECTIVE: To determine total energy expenditure (TEE) in patients with acute ischemic stroke in the territory of the middle cerebral artery (MCA), treated with moderate hypothermia (33 degrees C). DESIGN AND SETTING: Prospective study in a neurological ICU. PATIENTS: Ten consecutive patients with severe MCA infarction undergoing moderate hypothermia. MEASUREMENTS AND RESULTS: Indirect calorimetry was performed continuously over the first 6 days after admission. Mean daily TEE decreased significantly from 1549 before initiation of hypothermia to 1099, 1129, and 1157 on the first, second, and third days of hypothermia, respectively and returned to baseline values after hypothermia was terminated. The ratio of TEE to predicted basal energy expenditure declined from 1.01 before induction of hypothermia to an average of 0.74 during steady state of hypothermia and increased to 1.16 after rewarming. CONCLUSIONS: We found a significant fall in TEE in sedated, curarized, and ventilated ischemic stroke patients during moderate hypothermia. Indirect calorimetry appears to be a useful tool for measuring energy expenditure in these patients, as predicted basal energy expenditure overestimates the caloric requirements during hypothermia.

Adult↗
PubMed2003

Measurement and prediction of energy expenditure in males during household and garden tasks.

Participation in at least 30 min of moderate intensity activity on most days is assumed to confer health benefits. This study accordingly determined whether the more vigorous household and garden tasks (sweeping, window cleaning, vacuuming and lawn mowing) are performed by middle-aged men at a moderate intensity of 3-6 metabolic equivalents (METs) in the laboratory and at home. Measured energy expenditure during self-perceived moderate-paced walking was used as a marker of exercise intensity. Energy expenditure was also predicted via indirect methods. Thirty-six males [ X (SD): 40.0 (3.3) years; 179.5 (6.9) cm; 83.4 (14.0) kg] were measured for resting metabolic rate (RMR) and oxygen consumption ( VO(2)) during the five activities using the Douglas bag method. Heart rate, respiratory frequency, CSA (Computer Science Applications) movement counts, Borg scale ratings of perceived exertion and Quetelet's index were also recorded as potential predictors of exercise intensity. Except for vacuuming in the laboratory, which was not significantly different from 3.0 METs ( P=0.98), the MET means in the laboratory and home were all significantly greater than 3.0 ( P</=0.006). The sweeping and vacuuming MET means were significantly higher ( P<0.001) at home than in the laboratory, whereas the converse applied for window cleaning and lawn mowing. Measured RMR was significantly lower ( P<0.001) than the 1-MET constant. Estimating METs by fitting random intercept regression models to the data resulted in standard deviations for the "leave-one-out" prediction errors (predicted-measured) of 0.4 and 0.5 METs for the laboratory and home equations, respectively. While the means indicate that all the activities were performed at a moderate intensity, there was great inter-individual variability in energy expenditure. The laboratory and home-based equations predicted with correct classification rates of 89% and 88%, respectively, whether energy expenditure was <3.0 or >/=3.0 METs.

Activities of Daily Living↗
PubMed1991

Effect of reduced dietary intake on energy expenditure, protein turnover, and glucose cycling in man.

The effect of a 50% reduction in food intake on energy expenditure, protein metabolism, glucose cycling, and body composition was investigated in eight moderately overweight men. The prestudy mean calorie and protein intake was determined for eight subjects. They were then maintained on this diet for 6 weeks (mean +/- SEM, 3,269 +/- 75 kcal/d, 20.0 +/- 0.5 g N/d, period I), after which the diet was reduced uniformly in the major foodstuffs by 50% for the next 4 weeks (1,555 +/- 38 kcal/d, 9.6 +/- 5 g N/d, period II). At the end of each period we measured (1) body fat and fat free mass by underwater weighing, (2) 24-hour energy expenditure by indirect calorimetry in a calorimeter, (3) whole body protein synthesis and breakdown rates with 15N glycine, and (4) glucose cycling between glucose and glucose-6-phosphate and fructose cycling between fructose-6-phosphate and fructose-1,6 bisphosphate with 6,6-D2- and 2-D1-labeled glucose. The results were subjects lost 4.0 +/- 0.1 kg fat (by underwater weighing) during the 4 weeks on the reduced-energy regimen. Protein turnover and glucose cycling were reduced by 20% and 15%, respectively. Twenty-four-hour energy expenditure was 2,553 +/- 166 kcal/d for period I and 2,369 +/- 69 kcal/d for period II, giving a difference of 184 +/- 34 kcal/d between the two periods. In conclusion, (1) although energy intake was reduced by 50%, the decrease in energy expenditure was small due to the buffering effect of body fat.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1989

The effect of wheel running and the estrous cycle on energy expenditure in female rats.

In female rats, food intake and wheel running fluctuate with the estrous cycle, creating a state of oscillating energy balance. The effect of the estrous cycle on the energy expenditure of conventionally housed rats (S) and of rats given access to an activity wheel (A) was compared. Over 24 weeks, the weight gain of the groups was similar although the body fat content of A was 30 g lower than that of S at the end of the study. During the assessment of energy expenditure by indirect calorimetry estrous cycles were disrupted and food intake and wheel running reduced. However, a correlation between expenditure and wheel running was obtained from which the cost of activity was derived (21 kJ/kg/km) and from which data were extrapolated to normal circumstances. This revealed that A, running on average 6214 rev/day, expended approximately 64 kJ/day more than S. This they compensated for by increasing their food intake by 6 g/day (70 kJ/day). Over the estrous cycle wheel running was maximal at proestrus and minimal at metestrus--the reverse trend in food intake was observed. This cyclic difference in energy balance between metestrus and proestrus was estimated to be equivalent to 23% of the 'maintenance' requirement. Thus voluntary activity bears a marked impact on day to day energy balance but has little effect in the long-term since in the female rat intake is precisely regulated to meet expenditure.

Adipose Tissue↗
PubMed1991

Elevated energy expenditure in cancer patients with solid tumours.

Cancer patients (n = 106) and non-cancer subjects (n = 96) were classified as weight stable (n = 70) or weight-losing (n = 132). Cancer patients had elevated resting energy expenditure (REE) compared with either weight-losing (23.6 [0.4] vs. 20.5 [0.5] kcal/kg per day, P less than 0.001) or weight-stable controls (22.0 [0.6] vs. 17.9 [0.4], P less than 0.001). Cancer patients had increased fat oxidation irrespective of weight loss (1.24 [0.07] vs. 0.87 [0.04] mg/kg per min; 1.07 [0.04] vs. 0.78 [0.04], P less than 0.001). Elevated energy expenditure was counter-regulated by a decrease in thyroid hormones. Abnormal liver function had no impact on REE in either group. Heart rate was the most powerful factor for prediction of high energy expenditure in both patients and controls. Elevated energy expenditure was related to the increased heart rate in cancer patients in a significantly higher proportion than that in controls. Increased metabolic rate is a significant component behind weight loss in cancer disease, independent of malnutrition and an elevated adrenergic state may be a likely explanation.

Analysis of Variance↗
PubMed2005

Divergence of melanocortin pathways in the control of food intake and energy expenditure.

Activation of melanocortin-4-receptors (MC4Rs) reduces body fat stores by decreasing food intake and increasing energy expenditure. MC4Rs are expressed in multiple CNS sites, any number of which could mediate these effects. To identify the functionally relevant sites of MC4R expression, we generated a loxP-modified, null Mc4r allele (loxTB Mc4r) that can be reactivated by Cre-recombinase. Mice homozygous for the loxTB Mc4r allele do not express MC4Rs and are markedly obese. Restoration of MC4R expression in the paraventricular hypothalamus (PVH) and a subpopulation of amygdala neurons, using Sim1-Cre transgenic mice, prevented 60% of the obesity. Of note, increased food intake, typical of Mc4r null mice, was completely rescued while reduced energy expenditure was unaffected. These findings demonstrate that MC4Rs in the PVH and/or the amygdala control food intake but that MC4Rs elsewhere control energy expenditure. Disassociation of food intake and energy expenditure reveals unexpected divergence in melanocortin pathways controlling energy balance.

Amygdala↗
PubMed2005

Enteral nutrition delivery and energy expenditure in medical intensive care patients.

BACKGROUND AND AIMS: Delivery of enteral nutrition (EN) in critical illness is often inadequate. This prospective observational study addresses the implementation of enteral feeding in critically ill medical patients and its relation to energy expenditure. METHODS: All admissions to a university medical ICU over a period of one year were screened. Patients receiving EN for at least 7 days were followed up. The caloric target was a minimum of 20 kcal/kg/day. The feeding volume was increased daily by 500 ml and a maximum of 2000 ml/day was targeted to be achieved by day 4 of admission. Energy expenditure was measured with indirect calorimetry on day 3 or 5. RESULTS: Two hundred and thirtyone patients required artificial nutrition, of which 61 patients were enterally fed for 7 days. This group was followed for a total of 750 feeding days. The gastric route was used at the start, with a post-pyloric feeding required during follow-up in 36.1% of patients due to high gastric residual. EN was interrupted in 32.1% of the feeding days. The daily administered volume was 86.2 +/- 30.4% of the prescribed. The mean enteral caloric supply in relation to energy expenditure was between 39.2 +/- 34.6% on day 1 and 83.1 +/- 31.1% on day 6. The targeted maximum feed volume was achieved on day 4 in 75.4% of the patients. Patients with a delayed target time had a higher mortality rate than those with a target time of <4 days (73.3% vs. 26.1%), CONCLUSIONS: A high delivery-to-prescription rate could be achieved with a standardized enteral feeding protocol in critically ill medical patients. However, caloric delivery is much less than measured energy expenditure. Enteral feeding intolerance is associated with a high mortality rate.

Adolescent↗
PubMed2006

Effects of peanut oil load on energy expenditure, body composition, lipid profile, and appetite in lean and overweight adults.

OBJECTIVE: We evaluated the effects of peanut oil intake on appetite, energy expenditure, body composition, and lipid profile in lean and overweight adults. METHODS: In a parallel-arm, long-term feeding trial, lean and overweight participants received a daily peanut oil load in a milk shake equivalent to 30% of their resting energy expenditure for 8 wk. Forty-eight adults (24 lean and 24 overweight, 12 male and 12 female in each group) completed the protocol. Anthropometric indices, appetite, dietary intake, energy expenditure, and plasma lipids were monitored. RESULTS: Energy intake increased significantly in the overweight but not in the lean participants. A statistically significant body weight gain (median 2.35 kg) was also observed among the overweight subjects, although this corresponded to only 43% of the theoretical weight gain. Among overweight subjects, high-density lipoprotein cholesterol increased significantly and low-density lipoprotein cholesterol decreased at week 4, but neither concentration was significantly different from baseline at week 8. Similar, but less marked, changes were observed in lean subjects. Resting energy expenditure was 5% greater (P < 0.01) in the overweight group, but no significant difference was observed in the lean subjects. No marked differences of appetite were observed over time in either group or between overweight and lean participants. CONCLUSION: These data indicate that ingestion of peanut oil elicits a weaker compensatory dietary response among overweight compared with lean individuals. Body weight increased, albeit less than theoretically predicted. The weaker effect of whole nuts on body weight reported in previous studies suggests components other than oil may be responsible.

Adult↗
PubMedDate not supplied

Precision and accuracy of an ankle-worn accelerometer-based pedometer in step counting and energy expenditure.

BACKGROUND: Walking is a widely used approach to increase physical activity levels in obese patients. In this paper, we investigate the precision and accuracy of an ankle-worn dual-axis accelerometer (Stepwatch) and investigate its potential application as a predictor of energy expenditure. METHODS: Twenty healthy subjects (10 lean, 10 obese) wore spring-levered (Accusplit), piezoelectric (Omron HF-100), and Stepwatch pedometers. Subjects walked on a treadmill at 1, 2, and 3 mph and in a hallway at 1 and 1.85 mph, during which energy expenditure was measured. RESULTS: The Stepwatch counted 99.7 +/- 0.67% (mean +/- SEM) of the manual counts. In comparison, the Omron pedometer counted 61 +/- 3.3% and the Accusplit counted 26 +/- 2.8% of the manual counts at 1 mph although all pedometers were accurate (> 98% of counts) at 3 mph. In repeated measures, the Stepwatch produced negligible variance (SD = 0.36) over all speed whereas the other pedometers showed a large amount of variance at all speed (SD = 4-13). Stepwatch counts were predictive of walking energy expenditure corrected by weight (r2 > 0.8). CONCLUSION: The counts from the Stepwatch were virtually identical to the manual counts from a trained investigator and provided a reliable predictor of walking energy expenditure.

Adult↗
PubMed1996

Comparison of multiple-pass 24-hour recall estimates of energy intake with total energy expenditure determined by the doubly labeled water method in young children.

OBJECTIVE: This study determined the accuracy of the multiple-pass 24-hour recall method for estimating energy intake in young children by comparing it with measurements of total energy expenditure made using the doubly labeled water method. DESIGN: Three multiple-pass 24-hour recalls were obtained over a 14-day period to estimate mean energy intake. Total energy expenditure was measured over the same 14-day period under free-living conditions using the doubly labeled water technique. SUBJECTS/SETTING: Twenty-four children between the ages of 4 and 7 years were tested at the General Clinical Research Center/Sims Obesity Nutrition Research Center at the University of Vermont. STATISTICAL ANALYSIS: t Tests, paired t tests, Pearson product-moment correlation coefficients, pairwise comparison to show relative bias and limits of agreement, and regression analysis were used to test the relationships among study variables. RESULTS: No difference was found between 3-day mean energy intake and total energy expenditure for the group (t = 2.07, P = .65). The correlation between individual measures of energy intake and total energy expenditure was not statistically significant (r = .25, P = .24). CONCLUSIONS: Data from 3 days of multiple-pass 24-hour recalls were sufficient to make valid group estimates of energy intake. The method was not precise for individual measurements of energy intake.

Body Composition↗
PubMed1997

Lack of effect of sleep on energy expenditure and physiologic measures in critically ill burn patients.

OBJECTIVE: Energy expenditure measurements, performed while patients are in standardized resting conditions, are often used as an indicator of care by which to evaluate the adequacy of nutrition support regimens. Little attention has been directed toward examining potential errors incurred by deriving daily energy needs based on a single 15- to 20-minute measurement. This study was designed to differentiate energy expenditure during periods of sleep (defined as time spent in any of the standard sleep stages) and wakefulness in pediatric burn patients. DESIGN: Twenty-four-hour indirect calorimetry, polysomnography, and physiologic assessments (mean arterial pressure, heart rate, body temperature, oxygen saturation, and respiratory rate) were conducted simultaneously in 14 patients, who were thermally injured and tracheally intubated, for a total of 45 24-hour intervals. SUBJECTS: Mean age of the patients was 10.8+/-1.2 years. Mean total body surface area of the injury was 55.7+/-4.7%, and mean full-thickness burn was 48.8+/-6.0%. STATISTICAL ANALYSES PERFORMED: A nested general linear analysis of variance model was used to evaluate the association between sleep, wakefulness, and energy needs; adjustments were made for postburn day and multiple test runs per patient. RESULTS: On average, subjects slept 699+/-46 minutes/day. They experienced a large number of awakenings from sleep (mean=53+/-6.3 awakenings per 24 hours). Patients had mean energy expenditure of 2,529+/-396 kcal/day while awake and 2,360+/-291 kcal/day while asleep, and these mean values did not differ significantly. No differences in physiologic measurements during the awake and sleep states were found. APPLICATIONS: There appears to be little difference in the metabolism of seriously injured burn patients while asleep and while awake. The study deemphasizes the importance of performing indirect calorimetry at rest in critically ill pediatric burn patients, and it supports the extrapolation of daily energy expenditure from a 15- to 20-minute steady-state measurement obtained during either sleep or wakefulness.

Adolescent↗