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Determining Energy Requirements in Cirrhosis: an Update on the Role of Indirect Calorimetry

  • Nutrition in Patients with Chronic Liver Disease (A Montano-Loza, Section Editor)
  • Published:
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Abstract

Purpose of Review

Malnutrition in cirrhosis is associated with significant morbidity and mortality, and an accurate energy prescription is central to effective nutrition therapy. Indirect calorimetry is recommended to determine energy requirements, with novel handheld devices offering a simpler and lower cost assessment. This review summarises the published literature from 2010 to 2020 regarding the measurement of energy expenditure in patients with liver cirrhosis.

Recent Findings

Twelve studies involving 1039 patients were identified. Results indicate discordance between predicted and measured requirements in cirrhosis, with both underestimation (58%, n = 7) and overestimation (36%, n = 4) reported. The prevalence of hypermetabolism ranged from 5.3 to 58.3%. Heterogeneity in patient cohort, liver disease severity, and nutritional status impact observed results. In three studies involving handheld calorimetry devices, moderate agreement with metabolic carts was reported, with superior results to predictive equations when determining resting metabolic rate.

Summary

Predictive equations are inaccurate in cirrhosis, and indirect calorimetry should be used to guide nutrition interventions. Handheld devices are a promising tool to embed in clinical practice with further studies required to validate their use.

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Authors and Affiliations

  1. Nutrition and Dietetics Department, Austin Health, Melbourne, Australia

    Brooke Chapman

  2. University of Melbourne, Melbourne, Australia

    Brooke Chapman, Adam Testro, Paul Gow & Marie Sinclair

  3. Liver Transplant Unit, Austin Health, Melbourne, Australia

    Adam Testro, Paul Gow, Bethany Whitcher & Marie Sinclair

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Chapman, B., Testro, A., Gow, P. et al. Determining Energy Requirements in Cirrhosis: an Update on the Role of Indirect Calorimetry. Curr Hepatology Rep 20, 85–95 (2021). https://doi.org/10.1007/s11901-021-00564-y

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