Dietary energy density is associated with energy intake in palliative care cancer patients

Abstract

Diet energy density (ED) is associated with energy intake (EI) in cancer patients. There is limited information on the influence of patient characteristics on this association, potentially hampering individual tailoring of dietary treatment in clinical practice. We studied the relation between ED (kcal/g) and EI (kcal/kg body weight per day), using a mixed linear model estimating both overall and individual intercept and slopes with patient characteristics as covariates. Age, sex, body mass index (BMI), tumor type, tertiles of survival, weight loss, hypermetabolism, low muscle mass, low serum albumin, inflammation, handgrip strength, and fatigue were entered in the model, and significant effects were retained (p < 0.05). Dietary intake was obtained from 251 food records (995 days) in a group of unselected palliative care cancer patients. ED and EI were calculated for each day including all food and beverages. Mean EI was 25.8 kcal/kg/day. Age, BMI, fatigue, and survival were negatively associated and hypermetabolism was positively associated with EI. Effect estimates (1 SD) were: -1.9 kcal/kg/day for age, -3.8 kcal/kg/day for BMI, -1.5 kcal/kg/day for fatigue, and 1.1 kcal/kg/day for hypermetabolism. For tertiles of survival, the effect was -4.3 kcal/kg/day for 1st and -2.6 kcal/kg/day for 2nd, as compared to 3rd tertile. After adjustment, ED was still positively associated with EI with an overall effect of 4.5 kcal/kg/day per 1 SD. Age, BMI, fatigue, survival, and hypermetabolism are associated with EI, but do not substantially influence the association between ED and EI in palliative care cancer patients.