Energy Balance in Patients with Pressure Ulcers: A Systematic Review and Meta-Analysis of Observational Studies

Medical nutrition therapy is reported to contribute to wound healing. However, effective intervention requires an accurate estimation of individual energy needs, which, in turn, relies on accurate methods of assessment. The primary aims of this systematic review and meta-analysis were to evaluate the resting energy expenditure (REE) of patients with pressure ulcers (PUs) compared to matched control groups and the potential estimation bias of REE predictive equations. The recommended daily energy requirements of patients with PUs were also assessed, along with their energy balance (daily energy requirement vs intake). All language, original, full-text research articles published between January 1, 1950, and July 31, 2010, were searched through electronic databases. Relevant studies were also identified by reviewing citations. Observational (case-control and case-series) studies providing data on measured REE were initially included. Data extracted were measured REE, predicted REE, and daily energy intake. Five studies were included in the meta-analysis. Compared to controls (n=101), patients with PUs (n=92) presented higher measured REE (weighted mean 20.7±0.8 vs 23.7±2.2 kcal/kg/day; P