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Predictive Equations Overestimate Resting Metabolic Rate in Survivors of Chronic Stroke

  • Alice S. Ryan
    Correspondence
    Corresponding author Alice S. Ryan, PhD, Division of Gerontology and Palliative Medicine, BT/18/GR, 10 N Greene St BVAMC, Baltimore, MD 21201.
    Affiliations
    Division of Gerontology, Geriatrics, and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD

    Baltimore Veterans Administration Maryland Health Care System Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD
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  • Maria Novitskaya
    Affiliations
    Division of Gerontology, Geriatrics, and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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  • Alice L. Treuth
    Affiliations
    Division of Gerontology, Geriatrics, and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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Published:February 18, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.155

      Abstract

      Objective

      To measure resting metabolic rate (RMR) in survivors of chronic (>3 months prior) stroke (mean ± SEM age, 61±7.5 years) and to compare to predicted RMR using predictive equations in adults without stroke.

      Design

      Cross-sectional study.

      Setting

      Hospital.

      Participants

      Survivors of stroke (N=71).

      Intervention

      Not applicable.

      Main Outcome Measures

      RMR was measured by indirect calorimetry. Participants underwent a total body dual-energy x-ray absorptiometry scan and treadmill test for peak oxygen consumption (V̇o2peak). RMR was calculated using 9 established equations.

      Results

      RMR measured (1552±319 kcal/d) was significantly lower than 9 predicted RMR values (all P<.001), with the best being McArdle-Katch (1652±233 kcal/d), Livingston (1677±230 kcal/d), and Mifflin (1707±242 kcal/d). The Institute of Medicine of the National Academies (2437±386 kcal/d) had the largest discrepancy with measured RMR. Predicted RMR determined with 8 of 9 equations was between 9% and 18% greater than measured RMR. Appendicular lean mass (r=0.64, P<.001), total lean mass (r=0.64, P<.001), and V̇o2peak (r=0.41, P<.001) were associated with measured RMR.

      Conclusions

      RMR predictive equations established in adults without stroke are not appropriate for the population with stroke population, indicating the need to measure RMR until a more accurate predictive equation is developed. This could support modifications to nutritional intake guidelines in patients with conditions of muscle atrophy. If measurement of RMR is not feasible, the Katch-McArdle equation should be used to estimate RMR in a patient with stroke because on average it provides the lowest percentage overestimate compared with other equations.

      Keywords

      List of abbreviations:

      ALM (appendicular lean mass), DXA (dual-energy x-ray absorptiometry), IMNA (Institute of Medicine of the National Academies), RMR (resting metabolic rate), 6MWD (6-minute walk distance), V̇o2peak (peak oxygen consumption)
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