Energy expenditure in head and neck cancer: a systematic review and meta-analysis

Accurate estimation of energy needs is essential for effective nutrition interventions to improve outcomes in head and neck cancer (HNC). However, predictive equations used to estimate energy requirements may be inaccurate in cancer populations. To inform effective intervention delivery, this systematic review synthesised evidence regarding resting or total energy expenditure (REE or TEE) measured using reference methods (indirect calorimetry or doubly labelled water) in adults with any stage of HNC.

Four databases (Ovid MEDLINE, Embase, CINAHL plus, Cochrane Central Register of Controlled Trials) were searched, and eligible studies included comparisons of energy expenditure to non-cancer controls, predictive equations, wearable devices, or repeated measurements before and after treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Eleven studies (n = 439) were included. All measured REE using indirect calorimetry; none assessed TEE or wearable devices. One study compared REE to non-cancer controls (n = 40 per group) and found no significant difference. Pooled pre-treatment REE was 1502 kcal/day (10 studies, n = 431). Measured REE was higher than predicted (mean difference 110 kcal/day, p = 0.001, eight studies, n = 333, low certainty) and decreased following treatment (mean difference -140 kcal/day, p < 0.001, five studies, n = 176, low certainty); differences were < 10% of overall REE and not considered clinically important.

At the group level, REE was relatively stable throughout HNC treatment and reasonably estimated with predictive equations. However, to ensure accuracy in REE determination at the individual level, increased uptake of indirect calorimetry in HNC research is needed to guide clinical practice.

PROSPERO, 23 May 2024 (CRD 2024533495).