Resting energy expenditure and prediction equations in young children with failure to thrive

Objective: To compare predicted and measured resting energy expenditure (REE) in young children (birth to 3 years) with failure to thrive (FTT). Methods: REE (kcal/d) was measured by indirect calorimetry and compared with predicted REE from 3 sex and age group equations: World Health Organization (WHO), Schofield weight-based (SCH-WT), and Schofield weight- and height-based (SCH-WT-HT). The clinical characteristics associated with inaccuracy of predicted REE were examined. Results: Forty-five subjects (47% female) were evaluated. Their clinical characteristics (mean +/- SD) included age 1.2 +/- 0.7 years, length/height z score -2.1. +/- 1.3, weight z score -2.7 +/- 1.0, and measured REE 438 +/- 111 kcal/d. All prediction equations were within 10% accuracy <50% of the time. However, SCH-WT-HT did not significantly differ from measured REE (430 +/- 138 vs 438 +/- 111 kcal/d, P = .2) and was least likely to underestimate REE. Younger age and more severe growth failure (based on weight, length/height, or both) were associated with underestimation of REE by prediction equations. Conclusion: REE should be measured in young infants and children with moderate to severe FTT when knowledge of caloric needs is required for optimal clinical care. The SCH-WT-HT equation was least likely to underestimate REE and is therefore preferred when REE cannot be measured in this group of children.