9 Deviations from Regular Resting Energy Expenditure in Severely Disabled Children

Background: The resting energy expenditure (REE) in children is well investigated and has been clearly defined by the WHO in normative values. Measured data of REE in severely disabled, tetraspastic or -plegic children are not sufficiently available. But especially in this group we quite often realize excessive gain of weight and / or pathological deviations in body composition while the children receive a normocaloric diet according to age.Methods: In seven severely disabled (tetraspastic/-plegic) patients (age: 4 mo-14y) nine measurements of REE by indirect calorimetry were performed (sober in the morning). The collected data were compared with the normative values of the WHO according to age, weight and height. Further a randomised controll group of healthy children was investigated (n=10, age 2–11 mo) and the results were also compared with the WHO normative values. Statistics: Wilcoxon signed rank sum test, p<0,05.Results: Measured REE in the controll group was within the normal range of the suggested WHO values (59 kcal / kg body weight (BW) median, difference–0,9 median, p0,05). Measured REE in the severely disabled patients (33,3 kcal / kg BW, median) was statistically significant lower than the suggested WHO values (60 kcal / kg BW median, difference –16,8 median, p<0,01). In one patient with excessive gain of weight we even found only 1/8 of the suggested WHO REE.Conclusion: The agreement of the measured with the calculated REE in healthy children is a proof for the validity of the method. In disabled patients a significant difference to the normative values seems to exist. The underlying cause for this remains unclear. We speculate: 1) A different body composition (less fat free mass) leads to a reduced REE per kg BW in chronic immobile patients. 2) A higher metabolic level even in rest is found in healthy persons with regular physical activity due to bodily regeneration and therefore the REE in chronic immobile probands might be lower despite the same conditions during the measurement (30 min rest, thermoneutral surrounding, etc.).