Resting Energy Expenditure and Body Composition in Bedridden Institutionalized Elderly Women With Advanced-Stage Pressure Sores

Abstract

Background. Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size.

Methods. The study involved 52 institutionalized bedridden elderly women (aged 83.7 ± 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris–Benedict formula. PS area and volume were also measured.

Results. The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 ± 236.7 vs 1085.5 ± 161.3 kcal/d; p <.05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 ± 6.7 vs 21.1 ± 4.0 kcal/d/kg; p <.01). Hypermetabolism, i.e., a measured REE > 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (ΔREE) correlated with PS volume (r = 0.58; p <.01), but not with area.

Conclusion. Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.