Dear Munib,

Although established around 100 years ago, our students still use the Harris–Benedict prediction in the physical activity lab. Due to changes in lifestyle, new predictions such as the Mifflin St Jeor equation are more accurate. Working with obese patients (BMI 30 or more) the Broca-Index correction makes sense.

All these measurements simply rely on bodyweight, height, age and gender.

If you are able to measure lean body mass by bioelectrical impedance analysis you can predict the daily resting energy expenditure by Katch-McArdle and Cunningham formula, respectively.

Concerning you question, the difference between Harris–Benedict and Mifflin St Jeor equations is around 5 %, with higher accuracy of the later one.

Best wishes

Marc

Dear Munib,

Although established around 100 years ago, our students still use the Harris–Benedict prediction in the physical activity lab. Due to changes in lifestyle, new predictions such as the Mifflin St Jeor equation are more accurate. Working with obese patients (BMI 30 or more) the Broca-Index correction makes sense.

All these measurements simply rely on bodyweight, height, age and gender.

If you are able to measure lean body mass by bioelectrical impedance analysis you can predict the daily resting energy expenditure by Katch-McArdle and Cunningham formula, respectively.

Concerning you question, the difference between Harris–Benedict and Mifflin St Jeor equations is around 5 %, with higher accuracy of the later one.

Best wishes

Marc

thankyou Mr. Birringer

I manage the nutritionists in a large tertiary care facility.  This is what we currently use when evaluating adult patients.  We do not have a metabolic cart so we rely on the published research:

Obesity (BMI > 30)  When available, indirect calorimetry (metabolic cart) should be performed. 

For healthy/mildly ill (ex: cardiovascular disease, CVA, DM) the Mifflin-St Jeor equation using actual weight has been validated for estimating caloric needs. 

For acutely ill obese patients: If using Harris-Benedict equation--To estimate full calorie needs, use the average weight  (Average weight = (IBW + actual wt) ÷ 2) with a stress factor of 1.25 to 1.3.  Accuracy is within 10% of REE for 69% of  obese, spontaneously breathing patients. 51,52,53

For permissive underfeeding,  a reasonable initial goal in the obese hospitalized patient is achieved using an adjusted weight.51,52,53 (Adjusted weight = [(actual wt-IBW) x 0.25] + IBW) 

NOTE:  when permissively underfeeding, 2g pro/kg IBW is needed to promote nitrogen balance.54,55 Permissive underfeeding may not be appropriate for patients with renal or hepatic dysfunction.

Kcals per KgCaloric expenditure is significantly underestimated if ideal body weight (IBW) is used and significantly overestimated if actual body weight is used. Using Adjusted weight (Adjusted weight = [(actual wt-IBW) x 0.25] + IBW) with Kcals per Kg for patients with >130% IBW, resulted in predictions within 146 kcal of indirect calorimetry results.

Mifflin-St Jeor (Preferred method)Use with non-obese and obese patients

Derived from a sample of normal-weight, overweight, obese, and severely obese individuals aged 19 to 78 years

Predicts RMR within 10% of actual in the most people and creates the smallest errors when the results are erroneous.  This is true for non-obese and obese individuals, though accuracy rate is reduced in the obese.  In one study, the Mifflin–St. Jeor equation was accurate in 82% of non-obese and 70% of obese people, as compared to 69% and 64% using the Harris–Benedict equation. 30, 50 

 Harris-Benedict Equation (HBE) Developed using predominantly normal-weight white men     and women aged 15-74.  Accuracy ranges 45-80% in validation studies; overestimates occur more than underestimates.50

The use of an adjusted (.25) body weight in healthy obese patients should be avoided due to increased risk of underestimating nutrition needs.50 (May be used for permissive underfeeding if 2 g protein/kg IBW provided)Choban

Cachectic (< 50kg):  Harris Benedict underestimates, use Kcal Per Kg instead 48

Cachectic (> 50kg), BMI < 30:  use actual wt48, 52

BMI 30-50 to estimate full calorie needs, use average (Avg) wt with a stress factor of  1.25 to 1.351, 52, 53 

Avg wt = (IBW+actual wt)/2

Permissive underfeeding (BMI > 30), use adjusted (Adj) wt31 Adj wt = (actual wt-IBW)x0.25 + IBW

 NOTE:  when permissively underfeeding, 2g pro/kg IBW is needed to promote nitrogen balance. Permissive underfeeding may not be appropriate for patients with renal or hepatic dysfunction.

You may also want to check the paper by Henry (2005): https://www.ncbi.nlm.nih.gov/pubmed/16277825. In the paper, the equations are different according to age and sex.   

Thank you all.

thank you