Comparison of measured energy requirements and the Danish Health Authority’s recommendation estimates

INTRODUCTION: The Danish Health Authority (DHA) recommends a model for estimating total daily energy expenditure (TDEE) among inpatients at nutritional risk. This study aimed to investigate whether TDEE measured (M) by indirect calorimetry (IC) is equivalent to estimated TDEE (E) among medical patients and whether the agreement or lack thereof between E and M TDEE is associated with specific patient characteristics. METHODS: This cross-sectional study included anthropometrics, IC and data from medical records. The DHA E TDEE is based on body weight and stresses metabolism. Descriptive statistics, t-tests, logistic and linear regression analyses were performed. The study was registered with the North Jutland Protection Agency (2024-154). No grant was received for this study. RESULTS: Overall, 148 patients were included in the analysis. Among these, the mean age was 63.1 ± 15.0 years, and the mean BMI was 22.7 ± 5.0 kg/m2. Mean differences between E and M TDEE were seen in the total population (p less-than 0.001). Patients with a BMI less-than 25.0 kg/m2 were underestimated (p less-than 0.001), whereas patients with a BMI 25.0-29.9 kg/m2 were overestimated (p = 0.018), and those with a BMI > 30 kg/m2 were underestimated. Muscle mass was strongly associated with the difference between E and M (p less-than 0.001). CONCLUSIONS: Estimated TDEE underestimates TDEE in patients with a BMI less-than 25 kg/m2 and overestimates BMI above the recommended value. The difference is related to muscle mass. We suggest introducing a greater emphasis on muscle mass measurement. TDEE may be measured in patients at nutritional risk who lose weight, although dietary requirements are met. FUNDING: None. TRIAL REGISTRATION: Not relevant.