Measured and predicted energy expenditure among patients with distal bowel cancer: Results from the GAIN-project

The purpose of this study was to compare the agreement between measured and predicted energy expenditure in patients newly diagnosed with colon, rectal, or anal cancer.

In this cross-sectional study, resting energy expenditure (REE) was measured with indirect calorimetry in canopy mask mode using a COSMED Q-NRG device. Measurements were compared with predicted REE from five different equations, validated for healthy individuals. Total energy expenditure (TEE), calculated as measured REE multiplied by an estimated physical activity level (PAL) of 1.4 (referred to as Q-NRG-based TEE), was compared to the ESPEN recommendation of 25-30 kcal/kg/day. Agreements between the measured and predicted values were assessed.

Forty adults newly diagnosed with colon (n = 7), rectal (n = 23), or anal (n = 10) cancer were included (52 % males, body mass index (BMI) 27 ± 5 kg/m², age: 60 ± 8 years, measured REE: 1788 ± 383 kcal/day). All prediction equations underestimated REE compared to the measured REE. Wide limits of agreement were observed. The WHO/FAO/UNU equation had the narrowest limits of agreement (-587, 295 kcal/day). The mean predicted TEE, based on 30 kcal/kg/day, did not differ from the mean Q-NRG-based TEE. Further, this prediction showed a better agreement with Q-NRG-based TEE, as compared to 25 kcal/kg/day, although the limits of agreement were wide.

The prediction equations underestimated measured REE on a group level in patients newly diagnosed with distal bowel cancer. The results suggest that 30 kcal/kg/day could be used as an initial goal for TEE, but caution and close monitoring are needed to avoid a negative energy balance as the individual variations are large.