Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada.
Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland.
Am J Clin Nutr. 2023 Aug;118(2):422-432. doi: 10.1016/j.ajcnut.2023.06.002. Epub 2023 Jun 7.
Total energy expenditure (TEE) determines energy requirements, but objective data in patients with cancer are limited.
We aimed to characterize TEE, investigate its predictors, and compare TEE with cancer-specific predicted energy requirements.
This cross-sectional analysis included patients with stages II-IV colorectal cancer from the Protein Recommendation to Increase Muscle (PRIMe) trial. TEE was assessed by 24-h stay in a whole-room indirect calorimeter before dietary intervention and compared with cancer-specific predicted energy requirements (25-30 kcal/kg). Generalized linear models, paired-samples t tests, and Pearson correlation were applied.
Thirty-one patients (56 ± 10 y; body mass index [BMI]: 27.9 ± 5.5 kg/m; 68% male) were included. Absolute TEE was higher in males (mean difference: 391 kcal/d; 95% CI: 167, 616 kcal/d; P < 0.001), patients with colon cancer (mean difference: 279 kcal/d; 95% CI: 73, 485 kcal/d; P = 0.010), and patients with obesity (mean difference: 393 kcal/d; 95% CI: 182, 604 kcal/d; P < 0.001). Appendicular lean soft tissue (β: 46.72; 95% CI: 34.27, 59.17; P < 0.001) and tumor location (colon-β: 139.69; 95% CI: 19.44, 259.95; P = 0.023) independently predicted TEE when adjusted for sex. Error between measured TEE and energy requirements predicted by 25 kcal/kg (mean difference: 241 kcal/d; 95% CI: 76, 405 kcal/d; P = 0.010) or 30 kcal/kg (mean difference: 367 kcal/d; 95% CI: 163, 571 kcal/d; P < 0.001) was higher for patients with obesity, and proportional error was observed (25 kcal/kg: r = -0.587; P < 0.001; and 30 kcal/kg: r = -0.751; P < 0.001). TEE (mean difference: 25 kcal/kg; 95% CI: 24, 27 kcal/kg) was below predicted requirements using 30 kcal/kg (-430 ± 322 kcal/d; P < 0.001).
This is the largest study to assess TEE of patients with cancer using whole-room indirect calorimeter and highlights the need for improved assessment of energy requirements in this population. Energy requirements predicted using 30 kcal/kg overestimated TEE by 1.44 times in a controlled sedentary environment and TEE was outside of the predicted requirement range for most. Special considerations are warranted when determining TEE of patients with colorectal cancer, such as BMI, body composition, and tumor location. This is a baseline cross-sectional analysis from a clinical trial registered at clinicaltrials.gov as NCT02788955 (https://clinicaltrials.gov/ct2/show/NCT02788955).
总能量消耗（TEE）决定了能量需求，但癌症患者的客观数据有限。
我们旨在描述 TEE，研究其预测因素，并将 TEE 与癌症特异性预测能量需求进行比较。
这项横断面分析纳入了来自蛋白质推荐增加肌肉（PRIMe）试验的 II-IV 期结直肠癌患者。在进行饮食干预之前，通过 24 小时入住整个房间间接测热仪来评估 TEE，并与癌症特异性预测能量需求（25-30 kcal/kg）进行比较。应用了广义线性模型、配对样本 t 检验和 Pearson 相关分析。
共纳入 31 名患者（56±10 岁；体重指数 [BMI]：27.9±5.5 kg/m；68%为男性）。男性的绝对 TEE 更高（平均差异：391 kcal/d；95%置信区间：167，616 kcal/d；P<0.001），结肠癌患者的 TEE 更高（平均差异：279 kcal/d；95%置信区间：73，485 kcal/d；P=0.010），肥胖患者的 TEE 更高（平均差异：393 kcal/d；95%置信区间：182，604 kcal/d；P<0.001）。四肢瘦组织（β：46.72；95%置信区间：34.27，59.17；P<0.001）和肿瘤位置（结肠-β：139.69；95%置信区间：19.44，259.95；P=0.023）在调整性别后独立预测 TEE。用 25 kcal/kg（平均差异：241 kcal/d；95%置信区间：76，405 kcal/d；P=0.010）或 30 kcal/kg（平均差异：367 kcal/d；95%置信区间：163，571 kcal/d；P<0.001）预测的 TEE 与能量需求之间的误差在肥胖患者中更高，并且观察到比例误差（25 kcal/kg：r=-0.587；P<0.001；和 30 kcal/kg：r=-0.751；P<0.001）。使用 30 kcal/kg 预测的 TEE（平均差异：25 kcal/kg；95%置信区间：24，27 kcal/kg）低于预测需求（-430±322 kcal/d；P<0.001）。
这是使用整个房间间接测热仪评估癌症患者 TEE 的最大研究，强调了在该人群中需要改进能量需求评估。在受控的久坐环境中，使用 30 kcal/kg 预测的 TEE 高估了 1.44 倍，而 TEE 超出了大多数预测需求范围。在确定结直肠癌患者的 TEE 时需要特别考虑，例如 BMI、身体成分和肿瘤位置。这是一项在 clinicaltrials.gov 上注册为 NCT02788955（https://clinicaltrials.gov/ct2/show/NCT02788955）的临床试验的基线横断面分析。
