Proefschrift Kerklaan

Chapter 4

An RQ of administered macronutrients (RQ

macr

) was calculated based on the modified Lusk

table after determination of the ratio of carbohydrate to fat for the total nonprotein calories

of the intake provided on the day of the measurement

. The measured RQ was compared

to the RQ

macr

. The RQ was assumed to approximate the RQ

macr

, if RQ = RQ

macr

0.05

29,30

No corrections were made for losses of macronutrients in stools when EN was given

The following definitions of energy overfeeding were used and compared:

1) Caloric intake/mREE >110%

2) Caloric intake/mREE >120%

3) RQ > RQ

macr

+ 0.05

Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21.0

(Released 2012. SPSS Armonk, NY: IBM Corp.). Results are expressed as proportion, mean and

standard deviation, or median and interquartile range (IQR). Differences between groups were

analyzed by use of the Mann-Whitney and Kruskal-Wallis test. Pearson’s correlation coefficient

(r) was used to evaluate the strength of the relation between RQ and carbohydrate intake, and

between the continuous variables on which the definitions are based: RQ-RQ

macr

and the ratio

caloric intake/mREE. Linear regression analysis was used to further define the relation between

RQ-RQ

macr

and the ratio caloric intake/mREE. Two-tailed P-values <0.05 were considered

significant.

RESULTS

Patients

Measurements were performed in 78 children (51 boys). Clinical and nutritional characteristics

are shown in Table 2. Median age was 6.3 (Interquartile Range [IQR]1.5 to 29.3) months. An

SD-score for WFA<-2 was found in 23 children (30%). The reason for admission was medical in

77% of the children, with 32% respiratory insufficiency. The median length of stay at the time

of measurement was 1 day (IQR 1 to 3) after PICU admission. All children were mechanically

ventilated and sedated withmidazolam and/or morphine. Seventy-four percent of the children

received EN; 57% were fed by EN exclusively; and 18% received a mixture of EN and PN. Total

PN was provided in 15% of the children; 10% of the children received only glucose infusion at

time of measurement.