Interrelationships between body composition and energy expenditure in cancer malnutrition. The role of bioimpedance assessment.
OBJECTIVE
The aim of the experience was a case-control evaluation of the role of biological impedance assessment (BIA) for estimating resting energy expenditure (REE) instead of indirect calorimetry (IC) in cancer patients.


METHODS
Thirteen patients with gastric cancer (GK) were studied vs 18 control (C) patients. GK patients were depleted in fat free mass (FFM) (33+/-3 vs 44+/-5 kg; p<0.0001) and in body cell mass (BCM), (19+/-1 vs 26+/-3 kg; p<0.0001).


RESULTS
The REE, calculated with the Harris-Benedict formula (REE-HB) was higher in C than in GK (1,443+/-149 vs 1,196+/-109 Kcal/day; p<0.0001) despite that, when evaluated by means of Indirect Calorimetry (REE-IC), it showed similar values in both groups (1,456+/-157 vs 1,353+/-210 Kcal/day; p=NS; C vs GK), a remarkable decrease of BCM in GK notwithstanding. The REE-IC/actual weight ratio was 21+/-2 Kcal/kg/day in C and 25+/-3 Kcal/kg/day in GK (p<0.005) and the REE-IC/BCM ratio was 55+/-4 Kcal/kg/day in C, and 68+/-8 Kcal/kg/day, in GK (p<0.0001), with a significant correlation between BCM and REE-IC in controls vs GK.


CONCLUSIONS
The group of gastric malnourished cancer patients showed an increase in REE-IC in comparison with REE-HB; the increase in REE-IC was not related to the size of the remaining BCM; it is impossible to get a satisfying linear regression function expressing REE in terms of body composition measures obtained by means of BIA instead of indirect calorimetry; the IC is more appropriate to evaluate REE in cancer malnourished patients because in the present experience the Harris-Benedict formula underestimates this parameter by more than 10% (11.06%).
Department of Medicine, S. Martino Hospital, University of Genoa, Genoa, Italy. samir.sukkar@hsanmartino.liguria.it
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Bogdanovic