MEASUREMENT OF

ENERGY REQUIREMENTS
Kebutuhan Energi
 Kebutuhan energi didefinisikan sebagai asupan energi dari
makanan yang diperlukan untuk pertumbuhan dan fungsi
normal tubuh individu.
 Dengan memperhitungkan : usia, jenis kelamin, berat
badan, tinggi badan, dan tingkat aktivitas fisik
 Mengkonsumsi terlalu banyak / terlalu sedikit energi dari
kebutuhan normal tubuh akan berdampak pada perubahan
berat badan
 The total amount of energy required by an
individual consists of three basic components:
1. basal energy expenditure (BEE) or basal
metabolic rate (BMR)  60%
2. thermic effect of food (TEF)  10%
3. energy for physical activity or excercise (PA)

 Ketiga komponen tersebut membentuk kebutuhan energi

total individu, atau sering disebut
Total Energy Expenditure (TEE)
Basal Energy Expenditure ( BEE )
 Sering juga disebut Basal Metabolic Rate (BMR)
 Definisi : merupakan jumlah minimum energi yang dikeluarkan
individu.
 BEE mencerminkan jumlah energi yang digunakan selama 24 jam
sementara secara fisik dan mental dalm kondisi istirahat pada
lingkungan suhu netral sehingga mencegah aktivasi proses penghasil
panas
 Pengukuran BEE harus dilakukan sebelum seseorang melakukan
aktivitas fisik apa pun (lebih disukai saat bangun dari tidur) dan 10
hingga 12 jam setelah mengkonsumsi makanan dan minuman
 BEE / BMR measures your basal energy expenditure. The BEE is a 24
hour estimation of the number of calories you burn maintaining
your most basic bodily functions, such as breathing, circulating blood
and growing and repairing cells
 Selain BEE sering juga ada istilah Resting Energy Expenditure (REE) /
Resting Metabolic Rate (RMR).
 Both BEE/BMR, and REE/RMR, estimate the number of calories you
burn at rest, but REE/RMR takes additional factors into
consideration when determining needs.
 REE/RMR menentukan jumlah kalori yang Anda bakar dalam periode
24 jam dengan mempertahankan fungsi dasar tubuh, tetapi juga
mencakup jumlah kalori yang terbakar saat makan dan melakukan
sedikit aktivitas. REE, atau RMR, termasuk energi yang dibutuhkan
oleh sistem saraf pusat dan untuk pemeliharaan suhu tubuh.
 When comparing calorie estimations, RMR is slightly higher than
BMR, but the difference is less than 10 percent
 The Harris-Benedict equation is used to estimate BMR, while the
Mifflin-St Jeor equation is used to estimate RMR
 Due to these strict measurement requirements, actual
basal expenditure is in a practical sense theoretical and
thus difficult to measure  REE (resting energy
expenditure) or RMR (resting metabolic rate) is
used  resting in a comfortable position without any
other restriction
 RMR approximately 10% higher than BMR/BEE
 Resting Metabolic Rate (RMR) and Basal Metabolic Rate
(BMR) are measures of resting energy expenditure, which
can be helpful in assisting patients with weight loss.
 BMR and RMR represent the minimum amount of
energy required to keep your body functioning,
including your heart beating, lungs breathing, and
maintaining normal body temperature.
 Although the terms BMR and RMR are sometimes used
interchangeably, they are measured under different
conditions and have slightly different interpretation.
Faktor yang mempengaruhi REE / RMR
1. Body compotition. Fat free Mass / Lean body mass merupakan
komposisi jaringan di dalam tubuh yang merupakan prediktor
utama penentu REE. Fat free mass berkontribusi sebesar 80% pada
REE.
2. Ukuran tubuh. Semakin besar ukuran tubuh dan luas permukaan
tubuh seseorang maka semakin besar REE.
3. Usia. Usia mempengaruhi komposisi tubuh sehingga juga
mempengaruhi REE
4. Suhu udara lingkungan
5. Jenis kelamin. Jenis kelamin mempengaruhi komposisi tubuh
sehingga juga mempengaruhi REE
6. Hormonal
Thermic Effect of Food (TEF)
 TEF adalah pengeluaran energi yang terkait dengan
konsumsi, pencernaan, dan penyerapan makanan
 TEF memiliki porsi 10% dari TEE
 TEF sering juga disebut diet induced thermogenesis,
specific dynamic action, atau the specific effect of food
Energy for physical activity (PA)
 Beyond REE and TEF, energy is expended in physical
activity, either exercise-related or as part of daily work
and movement.
 This is referred to as activity thermogenesis.
 Activity thermogenesis (AT) includes nonexercise activity
thermogenesis (NEAT), the energy expended during
activities of daily living, and the energy expended during
sports or fitness exercise.
Measurement of energy expenditure
1. Calorimetry
2. Doubly labeled water
3. Calory Equation
Calorimetry Measurement
Indirect Calorimetry
Doubly labeled water
 The doubly labeled water (DLW) technique for measuring
TEE is considered the gold standard for determining
energy requirements and energy balance in humans.
 The DLW method is based on the principle that carbon
dioxide production can be estimated from the difference
in the elimination rates of body hydrogen and oxygen.
Energy Equation
 Persamaan kebutuhan energi merupakan cara yang mudah
dan murah untuk menentukan kebutuhan individu.
 Persamaan / rumus kebutuhan energi didapatkan dari
estimasi REE yang berasal dari pengukuran energi
menggunakan indirect calorimetry pada individu sehat
yang kemudian dirumuskan dalam suatu persamaa.
 Contoh persamaan kebutuhan energi yang sering kita
kenal adalah Harris-Benedict, Mifflin dan Persamaan Energi
dari Institute of Medicine (IOM).
Rumus Harris-Benedict
Harris-Benedict Formula
 Until recently, the Harris-Benedict equations were some
of the most widely used equations to estimate REE in
normal and ill or injured individuals (Harris and Benedict,
1919).
 The Harris-Benedict formulas have been found to
overestimate REE in normal weight and obese individuals
by 7% to 27% (Frankenfield et al, 2003).
 Rumus ini menggunakan estimasi BMR
Rumus Harris-Benedict
Rumus Mifflin-St.Jeor
Mifflin-St.Jeor Formula
 A study comparing measured REE with estimated REE using the Mifflin-St.
Jeor equations, Owen equations, and Harris-Benedict equations for males
and females found that the Mifflin-St. Jeor equations were most accurate in
estimating REE in both normal weight and obese people (Frankenfield et al,
2003).
 The Mifflin-St Jeor equations were developed from measured REE using IC
in 251 males and 247 females; 47% of these individuals had a body mass
index (BMI) between 30 and 42 kg/m2 (Mifflin et al, 1990)
 Mifflin-St. Jeor equations are used today to estimate energy expenditure of
healthy individuals and in some patients
 Dari beberapa penelitian rumus Mifflin merupakan rumus yang paling akurat
dan mendekati nilai REE menggunakan indirect calorimetry
 Rumus ini menggunakan berat badan aktual dalam menghitung kebutuhan
energi.
Rumus Mifflin-St.Jeor

REE
Rumus Institute of Medicine (IOM)
Rumus IOM
 Perhitungan kecukupan energi yang terkini didasarkan
model persamaan IOM (2005) dari meta analisis tim
pakar Institute of Medicine (IOM 2002).
 Model ini diperoleh dari data enersi basal (EB) yang
diukur dengan metode doubly labeled water yang lebih valid
dibanding model sebelumnya.
 Memiliki spesifikasi untuk golongan usia (IOM, 2005).
 Digunakan untuk individu sehat
USIA 0 – 9 TAHUN
USIA 10 – 18 TAHUN
USIA > 19 TAHUN
Contoh :
 LANSIA
 Mifflin-St. Jeor
Elderly Men = underestimates energy needs by up to 18%, overestimates by
5%
Elderly Women = underestimates energy needs by up to 31%, overestimates
by 7%

 Harris-Benedict
Elderly Men = underestimates energy needs by up to 19%, overestimates by
9%
Elderly Women = underestimates energy needs by up to 27%, overestimates
by 12%
Total kilokalorie requirements = BEE x Activity Factor x Injury
Factor
 BAYI – rumus cepat
Kondisi Sehat

UMUR (bulan) EER (kcal/hari)

0-3 (89 x BB [kg]) + 75
4-6 (89 x BB [kg]) + 44
7-12 (89 x BB [kg]) + 78
13-36 (89 x BB [kg]) - 80
 ANAK & REMAJA
 Estimated Energy Requirements (EER) untuk anak & remaja usia 3-18 tahun
pada keadaan sehat, dapat dihitung dengan rumus berikut:
UMUR (tahun) EER (kcal/hari)

Laki-laki = 108,5 – 61,9 x usia [thn] + PA x (26,7 x BB[kg] + 903 x tinggi [m])
3-8
Perempuan = 155,3 – 30,8 x usia [thn] + PA x 10,0 x BB [kg] + 934 x tinggi
[m])

Laki-laki = 113,5 – 61,9 x usia [thn] + PA x (26,7 x BB[kg] + 903 x tinggi [m])
9-18
Perempuan = 160,3 – 30,8 x usia [thn] + PA x 10,0 x BB [kg] + 934 x tinggi
[m])
 Equations for calculating REE and BMR (kcal/day) in
children from 3-10 years

Source Gender Equation

Male REE = 22,7 x BB (kg) + 495
WHO
Female REE = 22,4 x BB (kg) + 499

Male BMR = 22,7 x BB + 505

Schofield (W)
Female BMR = 20,3 x BB (kg) + 486

Male BMR = 19,6 x BB (kg) + 130,3 x TB (m) + 414,9

Schofield (WH)
Female BMR = 16,97 x BB (kg) + 161,8 x TB (m) – 371,2

Male REE = 66,47 + 13,75 x BB (kg) + 5,0 x TB (m) – 6,76 x U

Harris-Benedict
Female REE = 655,10 + 9,56 x BB (kg) + 1,85 x TB (m) – 4,68 x U
Equations for calculating REE and BMR (kcal/day) in children
from 10-18 years
Source Gender Equation
Male REE = 12,2 x BB (kg) + 746
WHO
Female REE = 17,5 x BB (kg) + 651

Male BMR = 13,4 x BB + 693

Schofield (W)
Female BMR = 17,77 x BB (kg) + 659

Male BMR = 16,25 x BB (kg) + 137,2 x TB (m) + 515,5

Schofield (WH)
Female BMR = 8,365 x BB (kg) + 465 x TB (m) + 200

Male REE = 66,47 + 13,75 x BB (kg) + 5,0 x TB (m) – 6,76 x U

Harris-Benedict
Female REE = 655,10 + 9,56 x BB (kg) + 1,85 x TB (m) – 4,68 x U
 Kebutuhan Khusus (1)
 Nutritional Support of Children in the Intensive Care
Unit (Seashore, 1984)
 Diterapkan pada anak usia < 15 tahun yang dalam
keadaan sakit/critically ill
 Estimasi REE WHO equation untuk anak sakit
UMUR (tahun) REE (kcal/hari)
Laki-laki = (60,9 x BB [kg]) - 54
0-3
Perempuan = (61,0 x BB [kg]) - 51
Laki-laki = (22,7 x BB [kg]) + 495
3-10
Perempuan = (22,5 x BB [kg]) + 499
Laki-laki = (17,5 x BB [kg]) + 651
11-18
Perempuan = (22,2 x BB [kg]) + 746
 Kebutuhan Khusus (2)
 Institute of Medicine (2005) dalam “Dietary Reference Intakes for Energy,
Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids
(Macronutrients)”
 Khusus digunakan pada anak dan remaja usia 3-18 tahun yang mengalami
overweight.
 Dasar pertimbangan : untuk mencapai berat badan ideal tanpa mengurangi
kebutuhan energi untuk “growth spurt”.
 Koefisien PA (physical activity) yang digunakan:
1. PA = 1,00 apabila PAL ≥1,0<1,4 (rendah)
2. PA = 1,12 apabila PAL ≥1,4<1,6 (sedang)
3. PA = 1,24 apabila PAL ≥1,6<1,9 (aktif)
4. PA = 1,45 apabila PAL ≥1,9<2,5 (sangat aktif)
LAKI-LAKI

TEE = 114 - (50,9 x umur [tahun]) + PA x

(19,5 x BB [kg] + 1161,4 x TB [m])

PEREMPUAN

TEE = 389 - (41,2 x umur [tahun]) + PA x

(15 x BB [kg] + 701,6 x TB [m])
TEE = Total Energy Expenditure
 LAKI-LAKI

BEE = 420 - (33,5 x umur [tahun]) + 418,9 x

TB [m] + 16,7 x BB [kg]

PEREMPUAN

BEE = 516 - (26,8 x umur [tahun]) + 347 x

TB [m] + 12,4 x BB [kg]

BEE = Basal Energy Expenditure

 DEWASA Sehat
Rumus Basal Energy Expenditure (BEE) Harris-Benedict

Laki-Laki = 66,47 + (13,75 x BB [kg]) + (5,0 x TB [cm]) – (6,76 x U

[tahun])
Perempuan = 655,10 + (9,56 x BB [kg]) + (1,85 x TB [cm]) – (4,68 x
U [tahun])

 Rumus Resting Metabolic Rate (RMR) Mifflin-St. Jeor

 Laki-Laki = (9,99 x BB [kg]) + (6,25 x TB [cm]) – (4,92 x U [tahun]) + 5

 Perempuan = (9,99 x BB [kg]) + (6,25 x TB [cm]) – (4,92 x U [tahun]) - 161
Rumus EER berdasarkan DRI untuk dewasa ≥ 19 tahun

Laki-Laki = 662 – (9,53 x U [tahun]) + PA

x {15,91 x BB [kg]) + (539,6 x TB [m]}

Perempuan = 354 – (6,91 x U [tahun] +

PA x {(9,36 x BB [kg]) + (726 x TB [m])}
 FAO/WHO Basal Energy Estimation
Umur Rumus
18-30 tahun (15,3 x BB [kg]) + 679
Men 30-60 tahun (11,6 x BB [kg]) + 879
>60 tahun (8,8 x BB [kg]) + (1128 x TB [m]) - 1071
18-30 tahun (14,7 x BB [kg]) + 496
Women 30-60 tahun (8,7 x BB [kg]) + 829
>60 tahun (9,2 x BB [kg]) + (637 x TB [m]) - 302

Sumber : Frankenfield D, Roth-Yousey L, Compher C. Comparison

of predictive equations for resting metabolic rate in healthy
nonobese and obese adults:a systematic review. J Am Diet Assoc.
2005 May;105(5):775-89.Review
 Setiap rumus memiliki keterbatasan masing-masing
 Penggunaan rumus Harris-Benedict dan Mifflin-St. Jeor
untuk dewasa normal
 Berdasarkan hasil penelitian, rumus Mifflin-St. Jeor lebih
akurat dalam menentukan kebutuhan energi pada
subyek obese-sehat dibandingkan Harris-Benedict
 ADA Expert Panel tidak menganjurkan penggunaan
Harris-Benedict pada kasus obesitas
 Pada tahun 2007, ADA menyelesaikan evidence analysis
terhadap berbagai metode penentuan kebutuhan energi
untuk mengklarifikasi metode mana yang paling mendekati
pemakaian energi sebenarnya.
 Dibedakan estimasi kebutuhan energi untuk:
1. Pasien sakit akut
2. Pasien sakit kritis
3. Pasien obesitas (BMI ≥ 30)
Kebutuhan Energi Pasien Sakit Akut
 RMR untuk overweight/obese menggunakan Mifflin
- St. Jeor dengan menggunakan BB aktual
Laki-laki = 5 + 10 W + 6,25 H – 5 A
Perempuan = 161 + 10 W + 6,25 H – 5 A
 Atau bisa menggunakan rumus Ireton-Jones (1997)
EER = 629 – 11 (A) + 25 (W) – 609 (o)
Note : (0)  obesitas ≥ 30% IBW (0 = tidak, 1 = ya)
Kebutuhan Energi Pasien Sakit
Kritis
 Menggunakan rumus Ireton-Jones (1992)
EER = 1924 – 11 (A) + 5 (W) + 244 (G) + 239 (T)
+ 804 (B)
Note:
G (gender)  perempuan (0), laki-laki (1)
T (trauma)  absen (0), ada (1)
B (burn)  absen (o), ada (1)
 Regimen Hipokalori untuk
Obesitas
 Rumus cepat : 22 Kkal/kgIBW

 HAMWI method for Ideal Body Weight

 Laki-laki : 48,1 kg untuk tinggi 152 cm  tambahkan 0,9 kg
tiap 1 cm kenaikannya
 Perempuan : 45,5 kg untuk tinggi 152 cm  tambahkan 1,1
kg untuk 1 cm kenaikannya
 Penentuan Energi untuk Febris
BEE meningkat 13% per kenaikan 1 ⁰C, atau 7% per
kenaikan 1 ⁰F
Langkah:
1. Tentukan BEE
2. Suhu normal =37 ⁰C  tentukan ∑ kenaikan!
3. ∑ kenaikan x 13% = % BEE yang perlu dinaikkan
4. BEE x % pada no. 3 = jumlah kenaikan BEE yang diperlukan
5. BEE + hasil perhitungan no. 4 = total kkal
 Contoh:
Misal, diketahui BEE 1500 kkal dan suhu 38,3 ⁰C
1. BEE = 1500 kkal
2. 38,3 – 37 = 1,3 ⁰C kenaikan suhu
3. 1,3 x 13 % = 16,9%
4. 1500 x 16,9% = 253,5 kkal
5. Total = 1500 + 253,5 = 1753,3 kkal
 LANSIA
 Mifflin-St. Jeor
Elderly Men = underestimates energy needs by up to 18%, overestimates by
5%
Elderly Women = underestimates energy needs by up to 31%, overestimates
by 7%

 Harris-Benedict
Elderly Men = underestimates energy needs by up to 19%, overestimates by
9%
Elderly Women = underestimates energy needs by up to 27%, overestimates
by 12%
Total kilokalorie requirements = BEE x Activity Factor x Injury
Factor
 Rumus cepat
Kelompok Lansia Kebutuhan Energi
Non-obese 25-35 kkal/kgBB
Obese, critically ill 21 kkal/kgBB
Paraplegik 28 kkal/kgBB
Quadriplegik 23 kkal/kgBB
 Rumus cepat
Kelompok Lansia Kebutuhan Energi
Non-obese 25-35 kkal/kgBB
Obese, critically ill 21 kkal/kgBB
Paraplegik 28 kkal/kgBB
Quadriplegik 23 kkal/kgBB
Luka Bakar
 TORONTO FORMULA
 Acute stages of burn injury, but must be assessed against
monitoring parameters, and adjusted with changes in those
parameters
REE (kcal) = -4343+(10.5xTBSA
burned)+(0.23xkcals)+(0.84xHarris Benedict)+(114xT(⁰C)-
(4.5xdays post-burn)
 TBSA = total body surface area burned, kcals = calorie intake
in past 24 hours, HB = HB equation with no stress or activity
factors, T = body temperature
 Activity factors : 1.2 (ventilator-dependent)
 Modified Harris Benedict Equation
 Male
BEE (kJ)=278+(57.5xkg Wt)+(20.9xcm Ht)-
(28.3xage)
 Female
BEE (kJ) = 2741+(40xkg Wt)+(7.7xcm Ht)-(19.6xage)
 EER = BEE <10
% Burn x IF (%11-20
burn) 21-30 31-50 50++
IF 1.2 1.3 1.5 1.8 2.0
 Modified Schofield Equation

Female BMR Male BMR

(kcal/day) (kcal/day)
15-18 tahun 13.3W+690 15-18 tahun 17.6W+656
18-30 tahun 14.8W+485 18-30 tahun 15.0W+690
30-60 tahun 8.1W+842 30-60 tahun 11.4W+870
>60 tahun 9.0W+656 >60 tahun 11.7W+585

 EER = BMR x IF x AF
 Injury factor (IF)
up to 10% burn 1.0-1.1
10-25% 1.1-1.3
25-90% 1.2-1.7
 Activity Factor (AF)
bed bound immobile 1.1
bed bound mobile/sitting 1.15-1.2
mobile on ward 1.25
 IRETON-JONES EQUATION
 used in the intensive care setting
 For spontaneously breathing patients
EEC (kcal) = 629-11(A)+25(W)-609(O)
 Ventilator-dependent patients
EEC (kcal) = 1784-11(A)+5(W)+244(G)+239(T)+804(B)
 O = obesity (>30% IBW, 0=absent, 1=present); G = gender
(0=female, 1=male); T = diagnosis of trauma (0=absent, 1=present);
B = diagnosis of burn (0=absent, 1=present)
 CURRERI FORMULA
 For all patients
25kcal/kg actual BW + 40 kcal/%TBSA burn
Kasus 1
 James has been gaining weight over the last five years in his group home
and his doctor has said that he needs to exercise more or he will become
obese. James is 62, a large man weighing around 200 pounds, who really
doesn't want to be told that he needs to exercise for his health. When
James first came to the group home he was much more active than
currently. He would go for walks in Sunrise Park by himself when the
weather was good and he seemed to enjoy that. He also bowled every
week with the other men in the group home and was very good at it. A
year later James climbed Mt. Clemons with one of the staff. Unfortunately,
the staff person left his job at the group home about three months later
and no one else was interested in taking him hiking. He worked out at the
YMCA for a period of time but he didn't find other people to workout
with him and he quit. We think that James started eating more food within
the next year as he started to gain weight.
Kasus 2
 Ms. Mellon is a 43year old woman who has lived in a Residential Habilitation Center
from age 11 to 40. For the last three years she has been in a Tenant Support
Program. This past year staff noticed that she had begun to lose weight. This became
a concern because she had always been rather slender. Staff had encouraged her to
eat more and had routinely prepared the foods she liked the most. Still, she was
losing weight and was about 15 pounds below her ideal weight. At a staff meeting to
discuss Ms. Mellon's food consumption, it was discovered that she was generally
eating breakfast but not lunch or dinner. While lunches and dinners were always
made and served to her, she often dumped the food in the garbage when staff
members were not present. She also was not drinking much water and staff
wondered if this was part of the problem. Because Ms. Mellon did not talk, staff
could not find out why she wasn't eating more than breakfast. Staff decided to use
the "Determine Your Nutritional Health Checklist" to see if she was at nutritional
risk and Ms Mellon had a total score of 11 points (high nutritional risk). It also was
becoming clear that Ms. Mellon was more lethargic and was sometimes disoriented
to time and place.
Kasus 3
 Carlton is 55 years old and about 30 pounds over weight. As a
younger man he hiked with his father and brother, which he enjoyed
very much. Unfortunately his father died several years ago and his
brother moved away after he married. Carlton was able to move
into half of a two-bedroom apartment. He generally liked people and
was always talking about wanting to go hiking again. When a new
support person started working, Carlton started telling him how
much he wanted to go on some hikes. Rob, the new support person,
agreed to take him on a hike but only if Carlton could get into
better shape. He also told him that it might take a few months, even
if Carlton was really excited. Rob knew that he had to get into
shape also.
Kasus 4