Resting energy expenditure and body composition in bedridden institutionalized elderly women with advanced-stage pressure sores

J Gerontol A Biol Sci Med Sci. 2007 Mar;62(3):317-22. doi: 10.1093/gerona/62.3.317.

Abstract

Background: Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size.

Methods: The study involved 52 institutionalized bedridden elderly women (aged 83.7 +/- 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured.

Results: The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 +/- 236.7 vs 1085.5 +/- 161.3 kcal/d; p <.05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 +/- 6.7 vs 21.1 +/- 4.0 kcal/d/kg; p <.01). Hypermetabolism, i.e., a measured REE > 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (DeltaREE) correlated with PS volume (r = 0.58; p <.01), but not with area.

Conclusion: Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.

MeSH terms

  • Absorptiometry, Photon
  • Adipose Tissue / pathology
  • Aged
  • Aged, 80 and over
  • Basal Metabolism / physiology*
  • Body Composition / physiology*
  • Body Height / physiology
  • Body Weight / physiology
  • Calorimetry, Indirect
  • Energy Metabolism / physiology
  • Female
  • Humans
  • Institutionalization*
  • Nutritional Status
  • Prealbumin / analysis
  • Pressure Ulcer / metabolism
  • Pressure Ulcer / pathology
  • Pressure Ulcer / physiopathology*
  • Retinol-Binding Proteins / analysis
  • Serum Albumin / analysis

Substances

  • Prealbumin
  • Retinol-Binding Proteins
  • Serum Albumin