energy sources will lead to dissolution of lean tissue stores. The requirement for energy may be measured by indirect calorimetry or estimated from urinary nitrogen excretion, which is proportional to resting energy expenditure. Basal energy expenditure (BEE) may also be estimated by the equations of Harris and Benedict:

- 4.68 (A) kcal/day where W is weight (kg), H is height (cm), and A is age (years).

These equations, adjusted for the type of surgical stress, are suitable for estimating energy requirements in more than 80% of patients. It has been demonstrated that the provision of 25-30 kcal/kg/ day will adequately meet energy requirements in most postsurgical patients, with low risk of overfeeding. The prescribed nutrient substrate requirements during long-term nutrition are to replace body nutrient stores and facilitate protein synthesis (Table 3). An appropriate nonprotein calorie:nitro-gen ratio of 150 to 1 (1gN = 6.25 g protein) should be maintained, which is the basal calorie provided to prevent use of protein as energy source. In the absence of severe renal or hepatic dysfunction precluding the use of standard nutritional regimens, approximately 0.25-0.35 g of nitrogen/kg of body weight should be provided daily.

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