Original article Resting energy expenditure in children with cerebral palsy: Accuracy of available prediction formulae and development of a population-specific formula Francesca Penagini a, * , Barbara Borsani b , Alessandra Bosetti b , Chiara Mameli a , Dario Dilillo a , Giulia Ramponi a , Francesco Motta c , Giorgio Bedogni d , Gian Vincenzo Zuccotti a a Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy b Pediatric Nutrition Unit, “V. Buzzi” Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy c Pediatric Orthopedic Unit, “V. Buzzi” Children's Hospital, Via Castelvetro 32, 20154 Milan, Italy d Clinical Epidemiology Unit, Liver Research Center, Building Q, AREA Science Park, Strada Statale 14 km 163.5, 34012, Basovizza, Trieste, Italy article info Article history: Received 16 November 2017 Accepted 3 April 2018 Keywords: Indirect calorimetry Resting energy expenditure Prediction formulae Cerebral palsy Children summary Background and aims: Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary for personalized nutritional intervention, is most commonly estimated using prediction formulae because the reference method, i.e. indirect calorimetry (IC), is not available in all Nutrition Units. The main aim of the present study was to evaluate the accuracy of the most commonly used REE prediction formulae in children with CP. The secondary aim was to develop a new population-specific formula for the estimation of REE in children with CP. Methods: REE was measured by IC in 54 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated from the five most commonly used prediction formulae, i.e. the World Health Organization (WHO), HarriseBenedict, Schofield weight, Schofield weight & height, and Oxford formulae. Results: The mean (standard deviation, SD) difference between the estimated and measured REE was 64 (238) kcal/day for the WHO formula, 79 (226) kcal/day for the Schofield weight formula, 79 (223) kcal/ day for the Schofield weight and height formula, 55 (226) kcal/day for the Oxford formula, 37 (224) kcal/ day for the HarriseBenedict formula and 0 (213) kcal/day for the purposely developed population- specific formula. Owing to the large SD of the bias, none of these formulae can be reliably applied at the individual level to estimate REE. Conclusions: The most commonly used REE prediction formulas are inaccurate at both the population and individual level in children with SQCP. A purposely developed population-specific formula, despite being accurate at the population level, does not perform better than the most commonly used REE formulae at the individual level. © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Malnutrition is highly prevalent among children with cerebral palsy (CP), ranging from to 46%e90% [1]. In children with CP, both under- and over-nutrition have a negative impact on linear growth, peripheral circulation, wound healing, spasticity, irritabil- ity, and respiratory and gastro-intestinal functions, with increased morbidity and reduced quality of life. Abbreviations: BC, body composition; CCF, classification fraction; CP, cerebral palsy; EE, energy expenditure; FFM, fat-free mass; IC, indirect calorimetry; REE, resting energy expenditure; RQ, respiratory quotient; SD, standard deviation; SQCP, spastic quadriplegic cerebral palsy; TEE, total energy expenditure; TSF, triceps skinfold; WHO, World Health Organization. * Corresponding author. E-mail address: Francesca.Penagini@unimi.it (F. Penagini). Contents lists available at ScienceDirect Clinical Nutrition ESPEN journal homepage: http://www.clinicalnutritionespen.com https://doi.org/10.1016/j.clnesp.2018.04.006 2405-4577/© 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Clinical Nutrition ESPEN 25 (2018) 44e49