Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Sit J, Cheung KS, Chiu TH, Fan TY,Yu MW
Affiliation :
Department of Dietetics, Queen Mary Hospital
Introduction :
Achieving optimal body weight is important in the care of NI children. Determination of the energy requirement (EE) of NI children is usually done with broad brushed equation-based approaches. This paper illustrates the possible use of IC for assessing their needs.
Objectives :
To assess the EE of complicated NI children with IC as compared to 3 equation-based approaches.
Methodology :
Overweight Boy A(15 years old) and underweight Boy B(11 years old) with NI were selected for measurements due to discordance between their intake with weight gain.
Boy A’s body height was 140cm(50-75th % CP GMFCS V growth chart), body weight was 44.2kg(75-90th % CP GMFCS V growth chart) and BMI was 22.5kg/m2(75-90th % CP GMFCS V growth chart) while Boy B’s body height was 138cm(75-90th % CP GMFCS V growth chart), body weight was 27.1kg(< 3rd % CP GMFCS V growth chart) and BMI was 14.2kg/m2(10-25th % CP GMFCS V growth chart).
Per European ESPGHAN Guidelines, EE for Boy A was 1401kcal and 1540kcal per Basel Energy Expenditure(BEE) method and per height method respectively while Estimated Average Requirement(EAR) for age was 2387kal. For Boy B, EE was 1161kcal and 1518kcal per BEE method and per height method respectively while EAR for age was 2050kal.
COSMED Q-NRG Indirect Calorimeter was used for determining REE. The children were fasted over 8hours before measurement. Measurements were carried out according to protocol for 30minutes.
After adjusting with activity factor and muscle tone, EE were determined as 739kcal for Boy A and 703kcal for Boy B. For Boy A, the current feed provides 150kcal in excess than the EE, while 46kcal more calorie was already provided to Boy B when compared to EE.
Finally, 92kcal(~10%) feed reduction was made for Boy A with addition of protein powder to keep muscle mass. Stepwise weaning off ketogenic diet with ~20kcal increment was made to Boy B.
After ~1 month of feed adjustment, Boy A’s body weight reduced from 44.2kg to 43.5kg(-1.6%). Boy B’s body weight increased ~16% from 27.1 to 31kg throughout 6months with BMI increased to 20-50th %
Result & Outcome :
IC is effective and more accurate than the commonly adopted equation-based approaches for determining nutritional requirement in complicated neurologically impaired children. IC should be considered in the future to provide individualized assessment of EE, taking into account the patients’ mobility, muscle tone, activity level, growth and current nutritional status.
