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For the total population, mean mREE was 48 (±9.6) kcal/kg compared to a mean caloric
intake of 52 (±29) kcal/kg/day. The mean RQ was 0.88 (±0.08). Fifty percent of the children
(n=39) were provided with >110% of mREE and 40% (n=31) with >120%. These children had a
significant lower SD-scoreWFA (-1.8 vs -0.5, p=0.004) and, as expected, had a significant higher
intake of calories (p<0.001), protein (p<0.001), fat (p<0.001), and carbohydrates (p<0.001) per
kilogram compared to the children without overfeeding. Children with an SD-score WFA<-2
had a significant higher intake of calories per kilogram than children with an SD-scoreWFA≥-2
(61 vs 48 kcal/kg/d, p=0.031). The ratio caloric intake/mREE was 119% in children with an SD-
score WFA<-2 and 100% in the children with an SD-score ≥-2 (p=0.091).
In 22%of the children (n=17) RQwas higher than RQ
macr
+ 0.05. Fourteen of these children (82%)
were also identified as overfed according to the ratio caloric intake/mREE >120% definition.
Children identified as overfed by RQ had a significant higher intake of calories (71 vs 44 kcal/
kg/d, p=0.001), protein (2.2 vs 0.9 g/kg/d, p<0.001), and fat (2.9 vs 0.9 g/kg/d, p<0.001) per
kilogram and a higher ratio caloric intake/mREE (71 vs 44 kcal/kg/d, p<0.001) compared with
the children with an RQ<RQ
macr
± 0.05. There was a significant positive correlation between
RQ-RQ
macr
and the ratio caloric intake/mREE (r=0.627, p<0.001) (Fig. 1). Caloric overfeeding as
defined by RQ (RQ exceeding RQ
macr
+ 0.05) occurred if the ratio caloric intake/mREE exceeded
165%, reflecting a mean caloric intake of 79 kcal/kg/day in our population.
Table 3.
Characteristics of children identified as overfed according to predefined definitions
Caloric intake/
mREE
>110%
N = 39
Caloric intake/
mREE
>120%
N = 31
RQ>RQ
macr
+0.05
N = 17
Male sex
N (%)
22 (56)
18 (58)
7 (41)
Age (months)
Median (IQR) 3.6 (1.0-17)
3.7 (1.0-18)
4.6 (1.7-15)
Weight (kg)
Median (IQR) 4.2 (3.4-8.8)
4.2 (3.4-8.8)
4.5 (3.5-8.4)
SD-score WFA
<-2
Mean (±SD)
N (%)
-1.9 (±1.8)
14 (36)
-1.8 (±1.7)
11 (36)
-1.8 (-3.8- -1.3)
8 (47)
mREE/kg
Mean (±SD)
50 (±8.3)
52 (±8.8)
50 (40-54)
RQ measured
Mean (±SD)
0.90 (± 0.08)
0.90 (± 0.08)
0.95 (0.93-0.98)
Intake
Kcal/kg/d
Protein g/kg/d
Fat g/kg/d
Carbohydrates mg/kg/min
Mean (±SD)
Median (IQR)
70 (±25)
1.7 (1.0-2.5)
2.5 (1.3-3.5)
6.8 (5.4-8.6)
71 (±24)
2.1 (±0.9)
2.9 (±1.5)
6.9 (5.7-8.6)
71 (53-92)
2.2 (1.3-2.5)
2.9 (2.0-4.1)
6.5 (3.7-8.4)
Route of nutrition
Exclusive EN
Exclusive PN
EN and PN
Glucose only
N (%)
26 (67)
6 (15)
6 (15)
1 (3)
21 (68)
4 (13)
6 (19)
-
11 (65)
2 (12)
4 (24)
-
IQR = Interquartile Range, SD = Standard Deviation, WFA =Weight for Age, PICU = Pediatric Intensive Care
Unit, mREE = measured Resting Energy Expenditure, RQ = Respiratory Quotient, EN = Enteral Nutrition,
PN = Parenteral Nutrition