Energy Expenditure Flashcards

1
Q

what is the first law of thermodynamics

A

energy is neither created nor destroyed, but instead, transformed from one form to another

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2
Q

what is a kilocalorie?

A

the amount of heat required to raise the temperature of 1 kg (liter) 1 degree C

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3
Q

what is a joule?

A

energy expended (work done) in applying a force of one newton through a distance of one meter

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4
Q

explain how direct calorimetry works

A

water (of a known constant temperature) passes from one ends of a jacket to the other; the temp of the water leaving the jacket is used to calculate energy expended

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5
Q

why don’t we use direct calorimetry

A

expensive
takes a lot of time to ensure there are no leaks/everything works properly

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6
Q

where do we still use direct calorimetry?

A

in bomb calorimetry with food
- food is lit on fire, the amount of heat it produces changes the temperature of the water
- nitrogen ash can be used to determine protein in food

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7
Q

direct calorimetry measures …

A

heat production

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8
Q

explain how indirect calorimetry works

A

O2 is needed to metabolize macronutrients and produce energy
the amount of energy released per liter of O2 consumed is specific for each substrate
if we can can accurately measure O2 consumption and CO2 production, we can estimate EE (we must know the substrate mix and RQ)

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9
Q

indirect calorimetry measures …

A

O2 consumption and CO2 production

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10
Q

RQ = __ / __

A

CO2 production / O2 production

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11
Q

RQ of carbs, fat, protein

A

carbs: 1.0
fat: ~0.7
protein: ~0.8

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12
Q

if we don’t have RQ, we would use ___

A

*5 kcal/liter O2 consumed

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13
Q

explain how doubly labled water works

A

a free living technique where the loss from the body of two isotopes reflects the CO2 production during the period

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14
Q

three other techniques for measuring energy expenditure (that are less accurate)

A
  1. heart rate
  2. accelerometer
  3. pedometer
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15
Q

define: RMR

A

the amount of energy required to keep the body functioning at rest plus the cost of arousal (i.e. breathing, blood circulation, body temp control, cell growth, brain/nerve function, heart function)

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16
Q

what factors influence REE

A
  • FFM/FM
  • sex
  • age
  • genetics
  • body tmp
  • menstural cycle (highest during leutal phase)
  • certain hormones/medications
  • fasting/severe dieting
  • overeating
  • exercise training
  • smoking
  • caffeine
  • extreme temperatures
  • injury/illness
  • growth
17
Q

define: thermic effect of food

A

obligatory: the amount of energy needed to digest, absorb, metabolize, and store nutrients (and non-nutrients) following a meal
facultative: loss of heat due to SNS activity
higher with protein, lower with fat

18
Q

explain the thermic effect of protein

A

the body has no storage capacity for protein and thus it needs to be metabolically processed immediately
specific metabolic costs
- high cost of urea production
- high ATP cost of peptide bond synthesis as proteins are synthesized
- high cost of gluconeogenesis

19
Q

define: adapative thermogenesis

A

change in MR leading to increased heat production vs. ATP coupling
can be as a result of environment such as cold acclimation, response to drugs/hormones, overeating

20
Q

explain how shivering/nonshivering contribute to EE

A

shivering: heat generation through muscle contraction (glycolysis)
non shivering: generation of heat in cold/metabolic processes other than muscle contraction
- brown adipose tissue provides heat to vital organs (mostly in small animals with high demands for maintenance of body temp)
- diet induced thermogenesis: assimilation of meal accompained by metabolic cost over and above TEF

21
Q

outpatient protocol for REE

A
  • overnight (12h) fast
  • no caffeine or ice water
  • no exercise for 24-48 hours
  • in energy balance (often assumed)
  • rest on bed w/ 30 degree elevation at head
  • 30 min collection - first 10 min thrown out
  • pt cannot fall asleep
22
Q

inpatient protocol for REE

A
  • must be hemodynamically stable
  • no overnight fasting necessary
  • no caffeine
  • rest on bed
  • 10 min collection - first 5 min thrown out
  • UUN may be measured to account for protein metabolism
23
Q

don’t perform REE on pts …

A

with chest tubes or air fistuals
receiving nitric oxide
ventilated with positive end-expiratory pressure >12

24
Q

measuring TEF protocol

A
  • standarized meal
  • measure increase in O2 consumption (+RQ) above rest for as long as 4-6 hours post meal
  • TEF typically peaks 1 hour after meals – may be higher at breakfast vs. lunch or dinner
25
Q

in the ICU EE can be influenced by

A
  • body temperature
  • healing + recovery
  • feeding (level + formula)
  • precense of spepsis
  • level of sedation
  • medications (adrenergic blockers, muscle relaxants, opiates, barbiturates)
  • therapy
  • family members
26
Q

why bother measuring indirect calorimetry?

A
  • gold standard in critical care
  • over 200 equations developed to predict REE
  • equation determined by regression analysis (wt, ht, age, sex)
  • large errors of estimation
  • critical to be accurate if feeding pt (EN/PN) and/or critically ill and/or on ventilator