Abstract When measurement of resting metabolic rate (RMR) by indirect calorimetry is necessary, following evidence-based protocols will ensure the individual has achieved a resting state. The purpose ...of this project was to update the best practices for measuring RMR by indirect calorimetry in healthy and non–critically ill adults and children found the Evidence Analysis Library of the Academy of Nutrition and Dietetics. The Evidence Analysis process described by the Academy of Nutrition and Dietetics was followed. The Ovid database was searched for papers published between 2003 and 2012 using key words identified by the work group and research consultants, studies used in the previous project were also considered (1980 to 2003), and references were hand searched. The work group worked in pairs to assign papers to specific questions; however, the work group developed evidence summaries, conclusion statements, and recommendations as a group. Only 43 papers were included to answer 21 questions about the best practices to ensure an individual is at rest when measuring RMR in the non–critically ill population. In summary, subjects should be fasted for at least 7 hours and rest for 30 minutes in a thermoneutral, quiet, and dimly lit room in the supine position before the test, without doing any activities, including fidgeting, reading, or listening to music. RMR can be measured at any time of the day as long as resting conditions are met. The duration of the effects of nicotine and caffeine and other stimulants is unknown, but lasts longer than 140 minutes and 240 minutes, respectively. The duration of the effects of various types of exercise on RMR is unknown. Recommendations for achieving steady state, preferred gas-collection devices, and use of respiratory quotient to detect measurement errors are also given. Of the 21 conclusions statements developed in this systemic review, only 5 received a grade I or II. One limitation is the low number of studies available to address the questions and most of the included studies had small sample sizes and were conducted in healthy adults. More research on how to conduct an indirect calorimetry measurement in healthy adults and children and in sick, but not critically ill, individuals is needed.
This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research ...literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.
Metabolic rate is generally assessed by use of equations in critically ill patients, but evidence pertaining to the validity of these equations in this population has not been systematically ...evaluated. This paper represents the first such systematic analysis in adult patients. A work group created by the American Dietetic Association identified pertinent peer-reviewed articles. The work group systematically evaluated these articles and formulated conclusion statements and grades based on the available evidence. Seven equations plus the Fick method were found to have validation work that met criteria for inclusion in this analysis. The Harris-Benedict equation with and without modifiers had the most validation work behind it (n=13), followed by Ireton-Jones (1992 and 1997) (n=9), Penn State (1998, 2003) (n=2), and Swinamer (n=1). Five studies pertaining to the Fick method met acceptance criteria. Based on these validation studies, the Harris-Benedict, Ireton-Jones 1997, and Fick methods can be confidently eliminated from use in assessment of energy expenditure in critically ill patients. The Penn State 2003, Swinamer, and Ireton-Jones 1992 equations may be useful in critically ill nonobese patients, whereas the Ireton-Jones 1992 and Penn State 1998 equations seem to be useful in obese patients. The strength of these conclusions is moderated because of limited and sometimes inconsistent data. More validation work is needed to confirm and increase the strength of these conclusions.
