Macro partitioning
In severely burned patients, delivering caloric intake exceeding 1.2 times resting energy expenditure (REE) increases fat mass accretion without attenuating the erosion of lean body mass.
For severe burn patients, feeding significantly above measured energy needs (specifically >1.2x REE) will not save muscle; it will only add fat. Since muscle loss is driven by the injury's metabolic response rather than just caloric deficit, excessive feeding is counterproductive for body composition, adding fat without preserving lean mass.
In surviving burned patients, caloric delivery beyond 1.2 x REE results in increased fat mass without changes in lean body mass.
Why this rating
Large observational cohort (n=250) and specific subgroup analysis (n=42) with DEXA measurements; however, it is observational, not a randomized controlled trial of feeding protocols.
Source
Energy Expenditure and Caloric Balance After Burn
David W. Hart et al. · Annals of Surgery · 2002
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