Related Experiment Video
Updated: Jul 7, 2026
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Resting energy expenditure in children newly diagnosed with stage IV neuroblastoma
Gloria J Green1, Sheila S Weitzman, Paul B Pencharz
1Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Insights
Malnutrition in children with stage IV neuroblastoma (NBIV) is common. This study found that increased resting energy expenditure (REE) is not the cause; decreased intake due to the tumor is likely responsible.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Metabolic Research
Background:
- Children diagnosed with stage IV neuroblastoma (NBIV) frequently present with malnutrition, affecting up to 50% of cases.
- The underlying causes of malnutrition in NBIV, particularly the role of resting energy expenditure (REE), require further investigation.
Purpose of the Study:
- To investigate whether an elevated REE contributes to malnutrition in children with NBIV.
- To determine if REE normalizes with cancer treatment.
- To assess changes in nutritional status in response to nutritional support during treatment.
Main Methods:
- Resting energy expenditure (REE) and nutritional status were evaluated in ten NBIV subjects at three key time points: diagnosis, after chemotherapy, and after tumor resection.
- Nutritional support was provided throughout the study period.
Main Results:
- No significant increase in REE was observed in NBIV patients at any stage of treatment (p = 0.29).
- Fifty percent of subjects exhibited malnutrition at the time of diagnosis.
- REE levels remained consistent across the evaluated treatment phases.
Conclusions:
- Malnutrition in stage IV neuroblastoma is not attributable to increased energy expenditure.
- Decreased nutritional intake, likely due to intra-abdominal mass effects and general malaise, is the probable cause of malnutrition in NBIV.
- Findings suggest that nutritional interventions should focus on enhancing intake rather than solely on increasing energy provision.
Abstract:
Children with stage IV neuroblastoma (NBIV) are often malnourished at time of diagnosis, observed as high as 50%. The emphasis of this study was to determine whether an increased resting energy expenditure (REE) is a causative factor. Our hypothesis was that children diagnosed with NBIV have an increased REE, which normalizes with cancer treatment. Changes in nutritional status from time of diagnosis in response to nutritional support were examined. REE and nutritional evaluation were obtained three times: at diagnosis before starting treatment, where tumor burden is expected to be highest; after two courses of chemotherapy, where some response to treatment is expected; and after surgical excision of the primary tumor, where there was presumably minimal residual disease. Ten subjects completed the study. Results showed that REE was not increased, and there was no significant difference between phases (p = 0.29). Fifty percent of our subjects were malnourished at diagnosis. Because REE is not increased in NBIV, it is concluded that malnutrition seen in NBIV is not due to increased energy needs, but is likely due to decreased intake because of the intra-abdominal mass and malignant malaise.
