Decoding Energy Expenditure in Colorectal Cancer Patients: Insights from the PRIMe Study

Ford, K.L. et al. (2023). Total energy expenditure assessed by 24-hour whole-room indirect calorimeter in patients with colorectal cancer: baseline findings from the PRIMe study. Am J Clin Nutr.

Published in American Journal of Clinical Nutrition. Katherine L Ford et al.

Abstract

Background: Total energy expenditure (TEE) determines energy requirements, but objective data in patients with cancer is limited.

Objective: We aimed to characterize TEE, investigate its predictors, and compare TEE with cancer-specific predicted energy requirements.

Design: This cross-sectional analysis included patients with stage II-IV colorectal cancer from the Protein Recommendation to Increase Muscle (PRIMe) trial. TEE was assessed by 24-hour stay in a whole-room indirect calorimeter prior to dietary intervention and compared to cancer-specific predicted energy requirements (25-30 kcal/kg). Generalized linear models, paired samples t-tests, and Pearson correlation were applied.

Results: Thirty-one patients (56±10 years; BMI: 27.9±5.5 kg/m²; 68% male) were included. Absolute TEE was higher in males (mean [95% CI] difference: 391 [167, 616] kcal/day; p<0.001), patients with colon cancer (279 [73, 485] kcal/day; p=0.010), and obesity (393 [-182, 604] kcal/day; p<0.001). Appendicular lean soft tissue (β [95% CI]: 46.72 [34.27, 59.17]; p<0.001) and tumor location (colon: 139.69 [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 (241 [76, 405] kcal/day; p=0.010) and 30 kcal/kg (367 [163, 571] kcal/day; 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 (25 kcal/kg; 95% CI: 24, 27 kcal/kg) was below predicted requirements using 30 kcal/kg (-430±322 kcal/day; p<0.001).

Conclusion: This is the largest study to assess TEE of patients with cancer by whole-room indirect calorimeter and highlights the need for improved determination 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, including BMI, body composition and tumor location. This is a baseline cross-sectional analysis from a clinical trial (ClinicalTrials.gov Identifier: NCT02788955) available at: https://clinicaltrials.gov/ct2/show/NCT02788955.