P1084Resting Energy Expenditure in Pediatric IBD: Discrepancies with Predictive Equations and Associations with Fatigue and Sleep Disturbances - A Cohort Study from a Regional Referral Centre

Background Pediatric inflammatory bowel diseases (pIBD) are frequently associated with malnutrition and growth impairment. Assessment of resting energy expenditure (REE) may help optimize nutritional management. The aim of this study was to compare measured and predicted REE in pIBD, investigate its associations with clinical parameters, and evaluate daily energy intake, assessed by a 24-hour dietary recall, in relation to recommended reference intake levels. Methods REE was measured by indirect calorimetry and compared with Schofield predictive equations and LARN (Reference Intake Levels of Nutrients and Energy for the Italian Population) reference values in children with pIBD during follow-up. Clinical data and disease activity were collected. Standardized questionnaires assessed quality of life (IMPACT-III), perceived fatigue (Q6 and Q32 of IMPACT-III), physical activity (Physical Activity Questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). In addition, we collected data using a 24-hour dietary recall to assess total daily energy intake. Results Forty-five patients were included (26 males; 24 ulcerative colitis, 21 Crohn’s disease); 26 were in remission and 19 had active disease (mostly mild). Measured REE differed significantly from Schofield predictions (p = 0.015) and LARN reference values (p = 0.032, Figure 1a). A trend toward higher REE was observed in active disease. As expected, weight-normalized REE (REE/kg) showed a strong inverse association with BMI (p < 0.0001). REE was inversely correlated with perceived fatigue (r = -0.319, p = 0.0373, Figure 1c), and poorer sleep quality tended to be associated with higher REE (r = -0.331, p = 0.0597, Figure 1c). No significant associations were found with physical activity or quality of life. In addition, we observed a statistically significant difference between the LARN-recommended daily caloric intake and the intake estimated by the 24-hour recall (p = 0.0039, Figure 1b), which was significantly lower and consistent with previously published data [1]. Conclusion The inverse association between REE and fatigue suggests a link between metabolism and symptom burden in pediatric IBD. A near-significant trend between poor sleep quality and higher REE indicates that sleep disturbances may increase energy expenditure, impacting nutrition and disease management. These findings, with the discrepancy between measured and predicted REE, support the clinical utility of indirect calorimetry in guiding personalized nutritional management. Reference: [1] Gatti S, Vallorani M, Quattrini S, Aloi M, Bramuzzo M, Felici E, Zuin G, Catassi GN, Grazian F, Ciacchini B, Panceri R, Catassi C. Dietary habits in Italian children with inflammatory bowel disease: A case-control multicenter study. J Pediatr Gastroenterol Nutr. 2024 Sep;79(3):602-609. doi: 10.1002/jpn3.12344. Epub 2024 Aug 6. PMID: 39108157. Conflict of interest: Dr. Carciofi, Annalisa: No conflict of interest Quattrini, Sara: No conflict of interest Borgiani, Francesca: No conflicts of interest Gagliano, Chiara: No conflict of interest Di Sario, Francesca: No conflict of interest Filipponi, Stella: No conflict of interest Torselletti, Cecilia: No conflict of interest Brusco, Mario: No conflict of interest Franceschini, Elisa: No conflict of interest Lionetti, Maria Elena: No conflict of interest Gatti, Simona: No conflict of interest