Prospective study of resting energy expenditure changes in head and neck cancer patients treated with chemoradiotherapy measured by indirect calorimetry.
OBJECTIVE
The prevalence of malnutrition is high in patients with head and neck cancer due to tumor location and coadjuvant treatment. We studied changes in resting energy expenditure (REE) during treatment with chemoradiotherapy and compared the measured REE by indirect calorimetry (IC) with the value estimated by the Harris-Benedict (HB) formula.


METHODS
Eighteen patients with head and neck cancer (15 men and 3 women, mean age 57 +/- 10.7 y, age range 30-71 y) entered the study. All patients were treated with radiotherapy (70.8 +/- 1 Gy, range 70-72) and received 37.4 +/- 3.5 fractions (range 32-42) and concurrent chemotherapy with cisplatinum (absolute doses of 400 to 1000 mg). Nutrition assessment included anthropometry (body mass index, triceps skinfold thickness, subscapular skinfold thickness, midarm circumference, and midarm muscle circumference) and tetrapolar bioimpedance (Holtain BC). The IC (kcal/24 h; Deltatrac II MBM-200) was performed after an overnight fast. Measurements were done before treatment, at weeks 2, 4, and 6 of treatment, at the end of treatment, and 2 wk after treatment.


RESULTS
Body mass index decreased during treatment from 24.7 +/- 4.4 kg/m(2) (range 16.9-31.4) to 22.3 +/- 4.2 kg/m(2) (range 15.1-29.6). REE (kcal/24 h) changed significantly during treatment (IC P < 0.05, HB formula P < 0.001). REE measured by IC appeared as a U-shaped curve, but REE estimated by the HB formula decreased during treatment. The HB underestimated REE measurements compared with IC. These differences were statistically significant before treatment, at the end of treatment, and 2 wk after treatment (P < 0.05) and showed a limited clinical agreement with the Bland-Altman method.


CONCLUSIONS
REE measured by IC significantly changed during chemoradiotherapy. It was higher before treatment, at the end of treatment, and 2 wk after treatment. The HB formula underestimated REE in these patients. IC is a suitable method for measuring REE in this cohort of patients.
García-Peris
Pilar
P
Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain. pgarciap.hgugm@salud.madrid.org
Lozano
Miguel Angel
MA
Velasco
Cristina
C
de La Cuerda
Cristina
C
Iriondo
Teresa
T
Bretón
Irene
I
Camblor
Miguel
M
Navarro
Carlos
C
D000328:Adult; D000368:Aged; D000886:Anthropometry; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001481:Basal Metabolism / Q000187:drug effects / Q000502:physiology; D002153:Calorimetry, Indirect / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D017097:Electric Impedance; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008433:Mathematics; D008875:Middle Aged; D009751:Nutritional Requirements; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015431:Weight Loss
D000970:Antineoplastic Agents