ORIGINAL COMMUNICATION Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice MM Reeves 1 * and S Capra 1 1 School of Public Health, Queensland University of Technology, Brisbane, Australia Objective: To determine current methods used by dietitians for estimating the energy requirement of a chronically and acutely ill adult patient and the variation in the application of methods. Design: A cross-sectional survey including a case study. Setting: Acute care adult hospitals in Australia. Subjects: A total of 307 dietitians (66.2% response rate). Intervention: Surveys were posted to hospitals. A reminder letter was sent to all hospitals 2 weeks after the initial posting and a follow-up survey was sent 6 weeks after the initial posting to non-respondents. Results: Respondents calculated a mean energy requirement for the case study of 978071410 kJ/day. One-third of respondents calculated energy requirement within 7500 kJ of the mean. Respondents primarily used the Schofield equations (67.4%) followed by the Harris–Benedict equations (25.9%) to estimate energy requirement. Estimates using the Schofield equations calculated the highest mean energy requirement. The median injury factor used in the calculations was 1.3 (1.0–1.5). The values and reasons for the selection of injury factors varied widely. Calculated energy requirement did not differ with the aims of nutritional careFmaintaining current weight (970071370 kJ/day) or increasing weight (979071380 kJ/day). Conclusion: There was considerable variation in the methods and factors used for estimating energy requirement, resulting in a wide range of calculated requirements. The application of prediction methods to individuals in acute care does not appear to be universally understood among dietitians. Dietitians require an understanding of the correct application, appropriate use, and limitations of these prediction methods. European Journal of Clinical Nutrition (2003) 57, 1530–1535. doi:10.1038/sj.ejcn.1601721 Keywords: energy requirements; prediction equations; injury factors; dietetic practice; nutritional care Introduction Prediction equations are commonly used by dietitians to estimate patients’ energy requirements (Schofield, 1985; Owen et al, 1986, 1987; Mifflin et al, 1990; Vinken et al, 1999). Although practical and easy to use, the accuracy of these equations is questionable. A recent review of methods for predicting energy requirements indicated that they may be less than ideal as the Western population has changed since their formulation (eg changes in body composition, lifespan, ethnicity) and the equations have poor predictive value at the individual level (Reeves & Capra, 2003). The provision of adequate nutrition support will ensure that patients attain and maintain a desirable body weight and improve nutritional status. The success of nutrition support relies on the provision of adequate energy and nutrients, which in turn is based on dietitians accurately estimating energy requirements (Roza & Shizgal, 1984), while avoiding any negative outcomes associated with under- or overfeeding (Coss-Bu et al, 1998; White, 1998; Flancbaum et al, 1999; Gibney, 2000). Theoretically, to maintain weight within 71 kg over 3 months, energy intake Received 18 November 2002; revised 22 December 2002; accepted 4 January 2003 *Correspondence: MM Reeves, School of Public Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Queensland 4059, Australia. E-mail: m.reeves@qut.edu.au Guarantor: MM Reeves. Contributors: MMR was the main author of the paper, initiated and designed the study, and carried out statistical analyses, interpretation and discussion of results. SC assisted in design of the study, interpretation and discussion of results, and contributed to writing the paper. European Journal of Clinical Nutrition (2003) 57, 1530–1535 & 2003 Nature Publishing Group All rights reserved 0954-3007/03 $25.00 www.nature.com/ejcn