Validation and improvement of the predictive equation for resting energy expenditure in advanced gastrointestinal cancer

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2020-05, Vol.73, p.110697-110697, Article 110697
• Main Authors: Ozorio, Gislaine Aparecida, Souza, Micheline Tereza Pires de, Singer, Pierre, López, Rossana Verónica Mendoza, Alves-Almeida, Maria Manuela Ferreira, Ribeiro-Junior, Ulysses, Waitzberg, Dan Linetzky
• Format: Article
• Language: English
• Subjects: Accuracy; Advanced gastrointestinal cancer; Age; Agreements; Basal Metabolism; Body composition; Body Mass Index; Body size; Calorimetry; Calorimetry, Indirect; Cancer; Cancer therapies; Confidence intervals; Correlation coefficient; Correlation coefficients; Electronic health records; Electronic medical records; Energy; Energy expenditure; Energy Metabolism; Esophagus; Evaluation; Fat-free body mass; Female; Formulas (mathematics); Gastrointestinal cancer; Gastrointestinal Neoplasms; Gastrointestinal tract; Head & neck cancer; Head and neck cancer; Heat measurement; Humans; Independent variables; Indirect calorimetry; Male; Men; Middle Aged; Nutrition; Nutritional status; Observational studies; Patients; Phase shift; Population; Predictive equations; Predictive Value of Tests; Regression analysis; Regression models; Reproducibility of Results; Resting energy expenditure; Retrospective Studies; Sarcopenia; Sex; Statistical analysis; Values; Women
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2019.110697

•This study looked at a validated prediction formula for the calculation of resting energy expenditure in patients with head and neck cancer.•We proposed a new prediction formula for the calculation of resting energy expenditure in patients with cancer of the gastrointestinal tract.•The formula includes data on sex, age, phase angle, and fat-free mass and requires validation. The usual predictive equations for estimating resting energy expenditure (REE) seem to be associated with significant inaccuracy in patients with advanced cancer. Recently, our group developed a predictive equation for patients with advanced head and neck cancer, showing a better accuracy when compared with indirect calorimetry. The aim of this study was to validate this predictive equation and, if necessary, to elaborate a new predictive equation for patients with advanced gastrointestinal (GI) cancer. This was a retrospective, unicentric observational study. Data regarding the characteristics of the study were collected using an electronic medical record from June 2016 to January 2018. The nutritional status was calculated by the body mass index (BMI). Patients with nutritional risk, by the Nutritional Risk Screening 2002, were subjectively evaluated in relation to the nutritional status by the Patient-Generated Subjective Global Assessment (PG-SGA). Sarcopenia was defined as fat-free mass index ≤17.4 kg/m2 for men and ≤15 kg/m2 for women. Body composition and phase angle values were evaluated by electrical bioimpedance. REE was measured by indirect calorimetry. The study included 109 patients with advanced GI tract cancer. Most were male (72.5%), ≥60 y of age (61.5%), and had cancer in the esophagus region (62.4%). Most patients had not undergone any treatment at the time of the examination. Regarding nutritional characteristics, the majority of the patients were malnourished by BMI (71.6%), with a deficit of lean mass (79.8%), sarcopenia (83.5%), and a phase angle below the fifth percentile for age, sex, and BMI, showing in addition to a poor nutritional condition, an impaired cellular integrity. Most of the patients were hypermetabolic (56.9%) and their caloric intake in the preceding 3 d was insufficient in 43.1%. Through the intraclass correlation coefficient (ICC), it was possible to observe the satisfactory agreement between the REE measured by the gold standard (calorimetry) versus the Souza-Singer's formula (ICC, 0.730; 95% confidence interval, 0.659–0.789; P < 0.001). When