Validity of Predictive Energy Expenditure Equations Compared to Indirect Calorimetry for Hospitalized Adults: An Evidence Analysis Center Scoping Review.
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Abstract
Background: Predictive equations are commonly used to estimate energy needs in hospitalized patients. Accurate estimations help prevent under- or overfeeding, both linked to adverse health outcomes.
Objective: This scoping review aimed to (1) summarize evidence evaluating the validity of predictive equations compared to indirect calorimetry in hospitalized adults and (2) compare outcomes of nutrition support guided by predictive equations versus indirect calorimetry.
Methods: The Academy of Nutrition and Dietetics' Evidence Analysis Center conducted a scoping review following methodologies adapted from Arksey and O'Malley, Levac et al., and the Joanna Briggs Institute. A comprehensive search was performed on December 4, 2024, in MEDLINE, CINAHL, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews. Included studies evaluated predictive energy equations or their use in guiding nutrition support in hospitalized adults (≥18 years), were published in English after 1996, and appeared in peer-reviewed journals. Two reviewers independently screened and extracted data using a standardized template. Findings were synthesized by population and equation type and presented in tables, figures, and heat maps.
Results: The review included 152 studies assessing the validity of predictive equations and nine studies evaluating their use in guiding nutrition support. Most were prospective cohort studies involving critically ill, mechanically ventilated patients. Over 65 predictive equations were identified; Harris-Benedict, Mifflin-St Jeor, and weight-based equations were most frequently evaluated.
Conclusion: There is substantial evidence on the validity of predictive equations for estimating energy needs in critically ill, hospitalized adults, and limited evidence on their role in guiding nutrition support. Targeted systematic reviews and subpopulation analyses are needed. Existing reviews on burns, obesity, and weight-based equations can inform practice. Further research should address disease-specific accuracy, cost-effectiveness, and clinical outcomes.
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The Journal of the Academy of Nutrition and Dietetics is the premier source for the practice and science of food, nutrition, and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. The Journal focuses on advancing professional knowledge across the range of research and practice issues such as: nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, foodservice systems, leadership and management, and dietetics education.
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