From the Guidelines
The daily caloric requirement for a 64-year-old patient with multiple morbidities is approximately 27 kcal/kg actual body weight/day.
Estimating Energy Requirements
- In the absence of indirect calorimetry (IC), total energy expenditure (TEE) for polymorbid older patients (aged ≥ 65 years) can be estimated at approximately 27 kcal/kg actual body weight/day 1.
- Resting energy expenditure (REE) can be estimated at 18-20 kcal/kg actual body weight/day with the addition of activity or stress factors to estimate TEE 1.
Considerations
- The accuracy of prediction equations in this population is low, and weight-based formulae should only be used as a starting point when estimating requirements 1.
- Clinicians should be aware of the limitations of using precise numbers on weight-based formulae and consider input from a suitable and experienced healthcare professional, such as a dietitian 1.
Special Considerations
- For severely underweight patients, REE can be estimated at 30 kcal/kg actual body weight/day, but this target should be cautiously and slowly achieved due to the risk of refeeding syndrome 1.
From the Research
Daily Caloric Requirements for a 64-year-old Patient with Multiple Morbidities
The daily caloric requirements for a 64-year-old patient with multiple morbidities can be estimated based on various factors, including basal metabolic rate (BMR), physical activity level, and overall health status.
- The energy requirements of older adults are influenced by factors such as age, sex, weight, height, and physical activity level 2, 3.
- A study on healthy men aged 63 to 77 years found that their basal metabolic rates (BMR) were 1622 +/- 189 kcal/day, which is 13% lower than that of younger men 2.
- The energy intake required to maintain body weight in sedentary older men was found to be approximately 1.6 times their BMR, which is around 2554 +/- 222 kcal/day 2.
- Another study suggested that the daily energy requirements of older adults may be higher than current worldwide recommendations, which suggest an energy intake of 1.51 times resting energy expenditure 3.
- For elderly patients with chronic kidney disease (CKD), the energy requirement has been estimated to be around 25-35 Kcal/Kg/d, which is lower than previous guidelines 4.
- The ESPEN guidelines on nutritional support for polymorbid medical inpatients provide recommendations on energy and protein requirements, but do not specify exact daily caloric requirements for patients with multiple morbidities 5, 6.
Factors Affecting Daily Caloric Requirements
The daily caloric requirements of a 64-year-old patient with multiple morbidities can be affected by various factors, including:
- Physical activity level: Sedentary patients may require lower energy intake, while more active patients may require higher energy intake 2, 4.
- Overall health status: Patients with chronic diseases such as CKD may require lower energy intake to prevent protein energy wasting and overweight/obesity 4.
- Body weight and composition: Patients with a higher body mass index (BMI) may require higher energy intake to maintain weight loss or prevent weight gain 3.