Applied nutritional investigationEnergy expenditure in the immediate postpartum period: Indirect calorimetry versus predictive equations
Introduction
The postpartum period is characterized by numerous physiologic and metabolic changes that are imprecise and unique to each woman [1]. Between the first and the 10th day after parturition, the immediate postpartum phase begins. During this phase, the changes in a woman's body are critical [2]. Due to the specific demands of this period, it is important to establish measures of comprehensive health care, including in the area of nutrition [3].
Nutritional care in postpartum women can prevent complications by minimizing weight retention after pregnancy. However, the shortage of nutritional recommendations for women in the postpartum period, especially on energy requirements, makes it difficult to establish a precise intervention [4], [5].
Several authors have supported the belief that a woman's energy expenditure during lactation can increase by 30%. This increase probably influences satiety control and may be associated with excessive energy consumption, causing an increase in rates of overweight and obesity [6], [7].
Given the lack of energy recommendations for the postpartum period, indirect calorimetry (IC) may represent a more accurate alternative to assessing women's energy expenditure during this period. Despite being considered one of the most accurate methods to estimate resting energy expenditure (REE) [8], only a few studies have used IC in women during the immediate postpartum period [9], [10].
In recent years, use of IC to study the energy requirements of different populations has become widespread and increasingly accessible [8]. However, due to the high cost of the necessary equipment, plus the increased time required for evaluation, this method is rarely used in clinical practice [11]. Thus, REE prediction equations remain the primary tool used in different scenarios.
Several REE prediction equations are described in the literature; however, to our knowledge, specific formulas for women in the postpartum period have not yet been developed [8], [12]. Therefore, it is important to assess the agreement and accuracy of prediction equations to appoint the best method for evaluating energy requirements for this population and to perform effective nutritional interventions.
The aim of the present study was to use IC to evaluate the REE in the immediate postpartum and to point out the most appropriate prediction equation to estimate REE.
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Sample and study design
This was a cross-sectional study conducted with women in the immediate postpartum period in a maternity department in a Brazilian city (Belo Horizonte, 1.43 million inhabitants, 330.9 km2) from August to December 2015. We included women between postpartum days 1 and 10, who presented good health status; there was no age restriction. According to Epi Info 7 software, we needed ≥50 participants for descriptive purposes and finite population [13]. The participants received oral and detailed
Results
For this study, we assessed 81 women in the immediate postpartum period. After data consistency analysis, we excluded those with an mREE <500 kcal (n = 2) [27], resulting in a final sample of 79 participants. Table 2 shows the characterization of the sample.
Among the participants, 96.2% reported breastfeeding, and 93% of those reported exclusive breastfeeding. No differences were found in mREE between mothers who breastfed versus those who did not (1214 versus 1244.9 kcal; P = 0.994) and
Discussion
This study found low agreement (<40%) and accuracy (<60%) of all prediction equations to estimate women's REE in the immediate postpartum period, and, in most cases, the results were overestimated. However, among the evaluated equations, HB and Schofield were the better predictors of REE for this population. The HB equation showed lower difference, better median of adequacy, and higher ICC, whereas Schofield had a higher percentage of accuracy and lower opposite agreement. The practice of
Conclusions
To our knowledge, this is the first study to assess the adequacy of prediction equations to estimate REE in women in the immediate postpartum period. The unsatisfactory results presented by all the evaluated equations indicate the need for continued studies on the subject, to propose the most suitable methods for determining the energy requirements, and to establish effective nutritional interventions for weight management and prevention of overweight/obesity and their consequent morbidities
Acknowledgments
The authors acknowledge the entire team of Nutrition and Dietetics Service, Maternity and Research Center of Risoleta Tolentino Neves Hospital for their support and partnership.
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This work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) through the grant of master's scholarship, and received financial incentive from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). The authors have no conflicts of interest to declare.