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Page 2 of 2 Bot et al. Hepatoma Res 2020;6:45 I http://dx.doi.org/10.20517/2394-5079.2020.62

After obtaining informed consent from 29 consecutive patients with cirrhosis and preparing for liver
transplantation, RMR was measured with desktop indirect calorimetry (Fitmate©, Cosmed) and compared
to the results estimated by the Harris and Benedict equation. Twenty-nine patients (79.3% male) with liver
cirrhosis had a mean (± 1.96 SD) estimated RMR with HB equation of 1771 (± 253) kilocalories, while
the mean measured RMR with Fitmate was 1,630 (± 322) kilocalories (P < 0.05). The mean (± 1.96 SD)
difference in RMR was 140 (± 240) kilocalories, with a minimum of -424 and a maximum of 510 kilocalories
difference. The Pearson correlation between measured and estimated RMR was R = 0.677 (P < 0.05), which
is a significant but not strong correlation [Supplementary Figure 1]. Large clinically relevant differences were
detected between measured and estimated RMR in patients with liver cirrhosis during screening for liver
transplantation. The most likely explanation for the discrepancy is the altered body composition and the
frequent presence of ascites in these patients. A limitation of the device used was that it measures VO but
2
[4]
calculates VCO . Indirect calorimetry devices that measure both VCO and VO are even more accurate .
2
2
2
In conclusion, for reliable dietary advice in patients with end-stage liver cirrhosis, RMR should be measured
with one of these newer easy-to-use devices, and should no longer be estimated with HB and other
equations. This can have potential beneficial effects on nutritional status and therefore frailty in patients with
liver diseases.

DECLARATIONS
Acknowledgments
We thank Mrs. Suzanne van Keeken, MSc and Anneke S. Donker for performing the measurements.

Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Bot D, Droop A, Tushuizen ME, van Hoek B

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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