Anoreksiya Nervoza Hastalarında Enerji Harcamasının Belirlenmesinde Kullanılan Yöntemler

Anoreksiya nervoza besin kısıtlaması ve diyet enerjisininazalmasına bağlı olarak patolojik ağırlık kaybı ilesonuçlanan bir psikiyatrik hastalıktır. Bu hastalığa sahipbireylerde tıbbi beslenme tedavisi büyük önem taşımaktadır.Anoreksiya nervoza hastalarında beslenme tedavisininuygulanmasında, hastayı beslenmeye bağlı oluşabilecek“refeeding” sendromu gibi ciddi komplikasyonlardankorumak için doğru enerji gereksiniminin belirlenmesiönemlidir. Toplam enerji harcamasının önemli bir bileşeniolan dinlenme enerji harcaması (DEH), DEH ölçümündereferans metot olan indirekt kalorimetre ile ölçülebilmektedir.İndirekt kalorimetreye ulaşım mümkün olmadığındaenerji harcamasının belirlenmesinde tahmin eşitlikleriklinikte kullanılabilmektedir. Bu eşitlikler arasında çeşitliaraştırmalarda geliştirilen; Harris-Benedict, Mifflin,WHO/FAO/UNU, Müller, Owen, Schofield gibi eşitliklerbulunmaktadır. Yapılan çalışma sonuçlarına göre, Harris-Benedict eşitliği DEH’yi referans metoda kıyasla daha fazlatahmin etmektedir. Schebendach eşitliği ise anoreksiyanervozalı adolesanlarda uygulanabilir görünmektedir veMüller eşitliği DEH ölçümünde kabul edilebilir sonuçlarvermektedir. Ayrıca, beden kütle indeksi 16-18,5 kg/m2arasında olan hastalarda Lazzer eşitliği DEH’yi tahminde iyisonuçlar vermektedir. Beden kütle indeksi 16 kg/m2nin altındaolan hastalarda ise DEH’yi doğru tahminde en iyi yüzdeyiveren eşitlikler arasında Huang ve De Lorenzo vardır. Sonuçolarak, günümüzde anoreksiya nervoza hastalarının beslenmetedavisinde enerji gereksinimini belirlemede DEH’ninhesaplanmasında en güvenilir yöntem indirekt kalorimetredir.İndirekt kalorimetreye ulaşılamadığı durumlarda hastanınbeden kütle indeksine göre doğruluk oranı yüksek eşitliklerinkullanımı enerji gereksinimini belirlemede kolaylıksağlayabilir.

Methods Used to Determine Energy Expenditure in Anorexia Nervosa Patients

Anorexia nervosa is a psychiatric disorder that results in pathological weight loss due to dietary restriction and reduced dietary energy. Medical nutrition therapy is of great importance in individuals with this disease. In the application of nutritional therapy in anorexia nervosa patients, it is important to determine the correct energy requirement to protect the patient from serious complications such as refeeding syndrome which may be caused by feeding. Resting energy expenditure (REE), an important component of total energy expenditure, can be measured by indirect calorimetry, which is the reference method for the measurement of REE. When it is not possible to reach the indirect calorimetry, the estimation equations can be used in the clinic to determine energy expenditure. Among these equations are equations such as Harris-Benedict, Mifflin, WHO/FAO/UNU, Müller, Owen, Schofield developed in various researches. According to the study results, Harris-Benedict equality estimates REE expenditure more than the reference method. Schebendach equality seems to be applicable to anorexia nervosa adolescents, and Müller equality yields acceptable results in the measure of REE. In addition, Lazer equality gives good results in estimating REE in patients with body mass index between 16-18.5 kg/m2. In patients with a body mass index below 16 kg/m2, there are Huang and De Lorenzo among the equations that give the best percentage of the correct estimate of REE. In conclusion, the most reliable method for the calculation of REE in determining the energy need for nutritional therapy of anorexia nervosa patients today is indirect calorimetry. The use of highly accurate equations relative to the body mass index of the patient when indirect calorimetry is unavailable can facilitate the determination of energy need..

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