HF: Measure Resting Metabolic Rate (RMR) in Adults
➤ If indirect calorimetry is available, the RDN should use a measured RMR,
which is then multiplied by a physical activity factor to estimate total
energy needs in adults with HF (NYHA Classes I–IV/AHA Stages B, C and
D). Measurement of RMR using indirect calorimetry is more accurate than
estimating RMR using predictive equations. (Consensus, Conditional)
HF: Estimate RMR in Adults
➤ If indirect calorimetry is not available, the RDN should use 22 kcal per kg
actual body weight (for normally nourished patients) to 24 kcal per kg actual
body weight (for malnourished patients) to estimate RMR, which is then
multiplied by a physical activity factor to estimate total energy needs in
adults with HF (NYHA Classes I–IV/AHA Stages B and C). In these patients,
measured RMR ranged from 22 kcal per kg actual body weight in normally
nourished patients to 24 kcal per kg actual body weight in malnourished
patients. (Fair, Conditional)
HF: Estimate RMR in Adults with Advanced HF
➤ If indirect calorimetry is not available, the RDN should use 18 kcal per kg
actual body weight to estimate RMR, which is then multiplied by a physical
activity factor to estimate total energy needs in adults with advanced HF
(NYHA Class IV/AHA Stage D). In these patients, the average measured RMR
using indirect calorimetry was 1,610 kcal per day (17.69 kcal per kg actual
body weight). (Consensus, Conditional)
HF: Estimate Total Energy Needs Using RMR and Activity Factors
in Adults
➤ The RDN should multiply the RMR (RMR, measured or estimated) by one
of the following physical activity factors to estimate total energy needs in
adults with HF (NYHA Classes I–IV/AHA Stages B, C and D):
• Sedentary: ≤1.0 – <1.4
• Low active: ≥1.4 – <1.6
• Active: ≥1.6 – <1.9
• Very active: ≥1.9 – <2.5
The Dietary Reference Intakes (DRI) Physical Activity Levels (PAL) represent
the ratio of total energy expenditure to basal energy expenditure and
are defined as sedentary, low active, active or very active. (Consensus,
Imperative)
