title: Dietary energy density is associated with energy intake in palliative care cancer patients.
abstract: OBJECTIVE
  Diet energy density (ED) is associated with energy intake (EI) in cancer patients. There is limited information on the influence of patient characteristics on this association, potentially hampering individual tailoring of dietary treatment in clinical practice.
  
  
  METHODS
  We studied the relation between ED (kcal/g) and EI (kcal/kg body weight per day), using a mixed linear model estimating both overall and individual intercept and slopes with patient characteristics as covariates. Age, sex, body mass index (BMI), tumor type, tertiles of survival, weight loss, hypermetabolism, low muscle mass, low serum albumin, inflammation, handgrip strength, and fatigue were entered in the model, and significant effects were retained (p < 0.05). Dietary intake was obtained from 251 food records (995 days) in a group of unselected palliative care cancer patients. ED and EI were calculated for each day including all food and beverages.
  
  
  RESULTS
  Mean EI was 25.8 kcal/kg/day. Age, BMI, fatigue, and survival were negatively associated and hypermetabolism was positively associated with EI. Effect estimates (1 SD) were: -1.9 kcal/kg/day for age, -3.8 kcal/kg/day for BMI, -1.5 kcal/kg/day for fatigue, and 1.1 kcal/kg/day for hypermetabolism. For tertiles of survival, the effect was -4.3 kcal/kg/day for 1st and -2.6 kcal/kg/day for 2nd, as compared to 3rd tertile. After adjustment, ED was still positively associated with EI with an overall effect of 4.5 kcal/kg/day per 1 SD.
  
  
  CONCLUSIONS
  Age, BMI, fatigue, survival, and hypermetabolism are associated with EI, but do not substantially influence the association between ED and EI in palliative care cancer patients.
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden. ola.wallengren@vgregion.se
authors.forename: Ola
authors.initials: O
authors.lastname: Wallengren
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bosaeus
authors.forename: Kent
authors.initials: K
authors.lastname: Lundholm
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet; D015930:Diet Records; D002149:Energy Intake; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000178:diet therapy* / Q000473:pathology; D010166:Palliative Care / Q000379:methods*; D015996:Survival Rate