Energy Expenditure In Cancer Patients Research Articles

Resting energy expenditure in cancer patients: Agreement between predictive equations and indirect calorimetry

Disorders of energy metabolism is a common phenomenon in cancer patients. Changes in resting energy expenditure (REE) combined with inadequate nutrition support appear to be causes of nutritional depletion in cancer patients. In clinical practice, REE is typically calculated using predictive equations. The aim of this study was to determine the agreement between REE estimated by predictive equations and REE measured by IC in Portuguese cancer patients. Differences in measured REE between patients with different types of digestive cancers were also assessed. REE was measured by indirect calorimetry (IC) in 61 patients with cancer diagnosis (gastric cancer, cholangiocarcinoma, pancreatic cancer, liver cancer and colorectal cancer). Measured REE values were compared with those estimated by equations of Harris-Benedict, Schofield, Ireton-Jones, Mifflin-St.Jeor and Barcellos I and II. Mean Respiratory Quotient (RQ) was 0.77±0.09, which indicates high lipids utilization as substrate. No statistically significant differences between REE or RQ from patients with different cancer types were observed. All equations underestimate REE: Harris-Benedict, mean difference-648 kcal (limits of agreement+627 to-1923 kcal); MifflinSt.Jeor, mean difference-694 kcal (limits of agreement+544 to-193 kcal); Schofield, mean difference-531 kcal (limits of agreement+662 to-1723 kcal); and Ireton-Jones, mean difference-556 kcal (limits of agreement+774 to-1887 kcal). Barcellos I and II showed lower mean difference when compared to measured REE,+59 and+52kcal, respectively, although presenting wide limits of agreement,+1542 to-1424 kcal and+1429 to-1326, respectively. Although Barcellos Equations underestimate less and enable more accurate average REE prediction in cancer patients, still present wide limits of agreement and therefore clinically important differences in REE estimation may be found at individual level. Our results support the appropriateness of measuring REE by IC to better adequate the nutrition support to cancer patients. Further research is needed to improve the current knowledge base of energy expenditure in cancer patients, and to improve the accuracy of existing predictive equations.

Comment on accuracy of predictive equations versus indirect calorimetry for the evaluation of energy expenditure in cancer patients with solid tumors - An integrative systematic review study

We read with great interest the article “Accuracy of predictive equations versus indirect calorimetry for the evaluation of energy expenditure in cancer patients with solid tumors - An integrative systematic review study” published by Mazzo et al. [1] and the Letter to the Editor published by Purcell et al. [2].

Requerimientos ajustados a la Desnutrición del Paciente Oncológico

Propósito de la revisión: Este artículo explica las causas de desnutrición en el paciente con cáncer y los requerimientos de energía y nutrientes específicos para esta población.
 Recientes Hallazgos: En la caquexia cancerosa del paciente tumoral existe una incrementada lipólisis, favorecida por una disminución de la actividad de la Lipoproteína Lipasa (LPL) del Tejido Adiposo Blanco (TAB) y que propicia un aumento de niveles de Triacilgliceroles (TAG) circulantes. No existe evidencia de que el soporte nutricional incremente el crecimiento tumoral.
 Extracto: La desnutrición en los pacientes con cáncer se debe a tres grandes grupos, el primero relacionado a nutrientes (su déficit, metabolismo, alteraciones de absorción), el segundo grupo por la presencia de la Caquexia Cancerosa y el tercer grupo relacionado con el tumor, el paciente y los tratamientos recibidos. De acuerdo a las Guías de la Sociedad Europea de Nutrición para pacientes con cáncer, se recomienda que si el gasto de energía en pacientes oncológicos no es medido específicamente a cada paciente se haga un cálculo de 25 - 30 Kcal/Kg de peso/día.

Resting energy expenditure in cancer patients at different clinical stages before its antineoplastic treatment

Resting energy expenditure in cancer patients at different clinical stages before its antineoplastic treatment

Role of brown adipose tissue in metabolic syndrome, aging, and cancer cachexia.

Brown adipose tissue (BAT) plays a fundamental role in maintaining body temperature by producing heat. BAT that had been know to exist only in mammals and the human neonate has received great attention for the treatment of obesity and diabetes due to its important function in energy metabolism, ever since it is recently reported that human adults have functional BAT. In addition, beige adipocytes, brown adipocytes in white adipose tissue (WAT), have also been shown to take part in whole body metabolism. Multiple lines of evidence demonstrated that transplantation or activation of BAT or/and beige adipocytes reversed obesity and improved insulin sensitivity. Furthermore, many genes involved in BATactivation and/or the recruitment of beige cells have been found, thereby providing new promising strategies for future clinical application of BAT activation to treat obesity and metabolic diseases. This review focuses on recent advances of BAT function in the metabolic aspect and the relationship between BAT and cancer cachexia, a pathological process accompanied with decreased body weight and increased energy expenditure in cancer patients. The underlying possible mechanisms to reduce BAT mass and its activity in the elderly are also discussed.

Non-surgical oncology - Guidelines on Parenteral Nutrition, Chapter 19.

Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase.

Assessing Energy Expenditure in Cancer Patients: A Pilot Validation of a New Wearable Device

Nutrition problems are common in cancer patients and are frequently due to metabolic derangements. Thus, accurately assessing energy expenditure (EE) is important in planning adequate nutrition support. Indirect calorimetry (IC) represents the gold standard method but is not always available or applicable to all settings. The purpose of this study was to preliminary compare a new wearable device, the SenseWear armband (SWA), to IC in cancer patients. Ten (6 M, 4 F) subjects (mean +/- SD: 56.6 +/- 13.3 years) affected by newly diagnosed acute myelogenous leukemia, undergoing induction chemotherapy, were prospectively enrolled. Resting EE (REE) was measured simultaneously by SWA and IC on admission (day 0) and at discharge (end). Total daily EE (TDEE) was determined by SWA 4 times during the stay (days 0, 7, 14, and end) and predicted values were calculated according to IC REE estimates (TDEE = IC x correction factor 1.2). Mean length of stay was 27.1 +/- 6.2 days. Bland-Altman plots revealed no significant differences between overall REE estimates (day 0 + end) performed by IC and SWA (mean +/- SD; 1645 +/- 282 vs 1705 +/- 278 kcal/d) and the correlation was high (r = 0.84; p < .0001). SWA TDEE showed a progressive reduction during the stay. No bias was detected between overall SWA TDEE (1799 +/- 153 kcal/d) and IC predicted TDEE (1974 +/- 176 kcal/d), but there was a wide 95% confidence interval (-672; +321 kcal/d). Moreover, the correlation between these values was significant (r = 0.68; p = .001). SWA seems to provide accurate and reliable estimation of REE and useful information on TDEE also in cancer patients. Its use appears promising. Validation studies on larger samples and different cancer types should be considered.

Clinical accuracy of the MedGem™ indirect calorimeter for measuring resting energy expenditure in cancer patients

To compare, in patients with cancer and in healthy subjects, measured resting energy expenditure (REE) from traditional indirect calorimetry to a new portable device (MedGem) and predicted REE. Cross-sectional clinical validation study. Private radiation oncology centre, Brisbane, Australia. Cancer patients (n = 18) and healthy subjects (n = 17) aged 37-86 y, with body mass indices ranging from 18 to 42 kg/m(2). Oxygen consumption (VO(2)) and REE were measured by VMax229 (VM) and MedGem (MG) indirect calorimeters in random order after a 12-h fast and 30-min rest. REE was also calculated from the MG without adjustment for nitrogen excretion (MGN) and estimated from Harris-Benedict prediction equations. Data were analysed using the Bland and Altman approach, based on a clinically acceptable difference between methods of 5%. The mean bias (MGN-VM) was 10% and limits of agreement were -42 to 21% for cancer patients; mean bias -5% with limits of -45 to 35% for healthy subjects. Less than half of the cancer patients (n = 7, 46.7%) and only a third (n = 5, 33.3%) of healthy subjects had measured REE by MGN within clinically acceptable limits of VM. Predicted REE showed a mean bias (HB-VM) of -5% for cancer patients and 4% for healthy subjects, with limits of agreement of -30 to 20% and -27 to 34%, respectively. Limits of agreement for the MG and Harris Benedict equations compared to traditional indirect calorimetry were similar but wide, indicating poor clinical accuracy for determining the REE of individual cancer patients and healthy subjects.

Nutritional support of the cancer patient.

Malnutrition, a common problem in cancer patients, adversely affects survival and quality of life. It results from several factors that alter nutritional intake and cause massive metabolic disturbances. Anticancer therapies may compound the malnutrition. Optimal nutrition improves therapeutic modalities and the clinical course and outcome. Oral nutrition should be used whenever possible; in patients unable to ingest adequate amounts orally, enteral and parenteral feedings are safe and effective.

Evaluation of mechanisms behind elevated energy expenditure in cancer patients with solid tumours

The aim of this study was to demonstrate significant factors behind elevated resting energy expenditure in weight-losing cancer patients. Therefore, weight-losing cancer patients (n = 60), with normal liver and kidney function tests, were randomized to receive one of four drug treatments for 5 days: (a) Propranolol 80 mg x 2 (beta-adrenoceptor blockade); (b) Indomethacin 50 mg x 2 (prostaglandin synthesis inhibition); (c) Morphine 5 mg x 3 (pain relief) or (d) Placebo x 2. A reference group of healthy well-nourished individuals were examined outside the formal randomization protocol and they received Propranolol 80 mg x 2. The cancer patients were randomized by a computer based algorithm stratifying for measured resting energy expenditure (REE), body composition, biochemical tests, previous therapy, tumour type and tumour stage. Resting energy expenditure was measured by indirect calorimetry in the morning after an overnight fast before and after drug treatment. beta-blockade reduced REE significantly in cancer patients from 1416 +/- 95 kcal day-1 to 1160 +/- 63 kcal day-1 (P < 0.02) and from 1472 +/- 69 vs, 1398 +/- 63 kcal day-1 (P < 0.01) in the well-nourished reference individuals. The reduction found in cancer patients (10%) was significantly larger than that in the group of reference patients (5%), (P < 0.01). Indomethacin, morphine or placebo did not induce any significant alteration in energy expenditure in our cancer patients. Propranolol treatment was associated with a significant reduction in plasma concentrations of free fatty acids (FFA), but not in plasma glycerol.(ABSTRACT TRUNCATED AT 250 WORDS)

Resting Energy Expenditure in Cancer Patients Before and After Gastrointestinal Surgery

The aim of this study was to assess the impact of surgical trauma on energy metabolism in cancer patients. Therefore, resting energy expenditure (REE) was determined before and after surgery in patients with newly detection gastric and colorectal cancer. Preoperative REE was measured in 104 patients. In 65 of these 104 patients REE was also measured on the seventh or eighth postoperative day. Postoperative REE was significantly higher than preoperative REE (mean +/- SD: 1471 +/- 238 vs 1376 +/- 231 kcal; p less than 0.001). After surgery 22 patients were hypermetabolic (REE greater than or equal to 115% predicted energy expenditure) compared with seven hypermetabolic patients before surgery. This hypermetabolism in the postoperative state can be explained by the administration of total parenteral nutrition (TPN), by an increased body temperature mainly as a consequence of postoperative complications and by the surgical trauma itself. Patients who received preoperative TPN (n = 12) showed a 10% increase in REE. Thirteen patients suffered from minor and major postoperative complications; postoperative REE in this group was increased by 10%. Forty patients who had undergone uncomplicated surgery showed a slight but significant increase of 3% in REE after operation. We conclude from this study that the increase in REE resulting from surgical trauma itself is modest at the seventh to eighth postoperative day. Therefore, energy requirements for patients undergoing major elective surgical stress are lower than generally presumed.

Elevated energy expenditure in cancer patients with solid tumours

Cancer patients ( n = 106) and non-cancer subjects ( n = 96) were classified as weight stable ( n = 70) or weight-losing ( n = 132). Cancer patients had elevated resting energy expenditure (REE) compared with either weight-losing (23.6 [0.4] vs. 20.5 [0.5] kcal/kg per day, P < 0.001) or weight-stable controls (22.0 [0.6] vs. 17.9 [0.4], P < 0.001). Cancer patients had increased fat oxidation irrespective of weight loss (1.24 [0.07] vs. 0.87 [0.04] mg/kg per min; 1.07 [0.04] vs. 0.78 [0.04], P < 0.001). Elevated energy expenditure was counter-regulated by a decrease in thyroid hormones. Abnormal liver function had no impact on REE in either group. Heart rate was the most powerful factor for prediction of high energy expenditure in both patients and controls. Elevated energy expenditure was related to the increased heart rate in cancer patients in a significantly higher proportion than that in controls. Increased metabolic rate is a significant component behind weight loss in cancer disease, independent of malnutrition and an elevated adrenergic state may be a likely explanation.

Evaluation of mechanisms behind elevated energy expenditure in cancer patients

Evaluation of mechanisms behind elevated energy expenditure in cancer patients

Evaluation of mechanisms behind elevated energy expenditure in cancer patients : [formula omitted], Christer Drott, Ulla Körner, Rolf Sandström & Kent Lundholm Surgical Metabolic Research laboratory, Sahlgrens Hospital Gothenburg Sweden

Evaluation of mechanisms behind elevated energy expenditure in cancer patients : [formula omitted], Christer Drott, Ulla Körner, Rolf Sandström & Kent Lundholm Surgical Metabolic Research laboratory, Sahlgrens Hospital Gothenburg Sweden

Energy expenditure in malnourished cancer patients.

It is widely believed that the presence of a malignancy causes increased energy expenditure in the cancer patient. To test this hypothesis, resting energy expenditure (REE) was measured by bedside indirect calorimetry in 200 heterogeneous hospitalized cancer patients. Measured resting energy expenditure (REE-M) was compared with expected energy expenditure (REE-P) as defined by the Harris-Benedict formula. The study population consisted of 77 males and 123 females with a variety of tumor types: 44% with gastrointestinal malignancy, 29% with gynecologic malignancy, and 19% with a malignancy of genitourinary origin. Patients were classified as hypometabolic (REE less than 90% of predicted), normometabolic (90-110% of predicted) or hypermetabolic (greater than 110% of predicted). Fifty-nine per cent of patients exhibited aberrant energy expenditure outside the normal range. Thirty-three per cent were hypometabolic (79.2% REE-P), 41% were normometabolic (99.5% REE-P), and 26% were hypermetabolic (121.9% REE-P) (p less than 0.001). Aberrations in REE were not due to age, height, weight, sex, nutritional status (% weight loss, visceral protein status), tumor burden (no gross tumor, local, or disseminated disease), or presence of liver metastasis. Hypermetabolic patients had significantly longer duration of disease (p less than 0.04) than normometabolic patients (32.8 vs. 12.8 months), indicating that the duration of a malignancy may have a major impact upon energy metabolism. Cancer patients exhibit major aberrations in energy metabolism, but are not uniformly hypermetabolic. Energy expenditure cannot be accurately predicted in cancer patients using standard predictive formulae.

Glucose turnover, gluconeogenesis from glycerol, and estimation of net glucose cycling in cancer patients.

A double isotope method was used in patients with progressive malignancy and in control patients to measure: glucose turnover, conversion rate of carbon skeleton of glycerol into glucose, and the interorgan cycling of glucose carbons (Cori-cycle plus alanine-glucose cycle). [U-14C]glycerol and [6-3H]glucose were given intravenously as a single dose injection. The time course of the specific radioactivities of [6-3H] and [U-14C]glucose was followed in blood. The pool size and the turnover rate of glucose were increased in the cancer group as compared with the control patients. The net recycling of glucose carbons was not increased in the cancer group, despite the increased turnover of glucose. The alterations in the metabolism of glucose did not correlate with the plasma levels of insulin or thyroid hormones (T4, T3, rT3) neither in the entire cancer group nor in those cancer patients who were repeatedly investigated at different intervals of time. The turnover rate of glucose in the cancer patients correlated inversely to their body weight index. The gluconeogenesis rate, given as the fractional conversion rate of the injected radioactive dose of [14C]glycerol, or as mol glucose . kg body weight-1 . day-1, was increased in the cancer group, but still contributed only 3% of the glucose turnover rate in both cancer and control patients. We conclude that an increased gluconeogenesis from glycerol is not significant in terms of energy expenditure in patients with progressive malignancy, as has previously been concluded for the gluconeogenesis from alanine. It seems that increased turnover of glucose may contribute to inappropriately high energy expenditure in cancer patients.