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Published on: May 31, 2018
Resting energy expenditure in children with cancer undergoing chemotherapy using indirect calorimetry: A longitudinal
D Froon-Torenstra1, L Renting1, I IJpma1
1Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Insights
Resting energy expenditure (REE) in children with cancer did not change during chemotherapy. Measured REE (mREE) did not differ by body composition, but the Schofield equation (pREE) should be used cautiously in this population.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Metabolic Research
Background:
- Malnutrition is prevalent in pediatric cancer patients, impacting treatment toxicity, mortality, and quality of life.
- The role of resting energy expenditure (REE) changes in the development of malnutrition in these children remains unclear.
Purpose of the Study:
- To investigate alterations in measured REE (mREE) in children with cancer during the first nine months of chemotherapy.
- To determine if mREE per kilogram fat-free mass (mREE/kgFFM) varies across different body composition profiles.
- To compare mREE with predicted REE (pREE) using the Schofield equation to assess its accuracy in this population.
Main Methods:
- A longitudinal study involving 76 children with cancer, measuring mREE via indirect calorimetry at three time points.
- Analysis of mREE/kgFFM differences over time and associations with age, sex, and tumor type.
- Comparison of mREE with pREE using the Wilcoxon signed-rank test and Bland-Altman plots.
Main Results:
- mREE/kgFFM showed no significant changes across the treatment period.
- Age was inversely associated with mREE/kgFFM, but sex and tumor type were not.
- mREE differed significantly from pREE at early time points, indicating potential inaccuracies of the Schofield equation.
Conclusions:
- Resting energy expenditure remains stable during chemotherapy in children with cancer.
- mREE/kgFFM is not influenced by tumor type or body composition variations.
- The Schofield equation requires cautious application in pediatric cancer patients due to potential clinical relevance of individual differences.
Background And Aims:
Malnutrition is common among children with cancer and is related to treatment-related toxicity, mortality and lower quality of life. So far, it remains unknown whether changes in resting energy expenditure (REE) contribute to the development of malnutrition. Here, we explored alterations in measured REE (mREE) in children undergoing chemotherapy during the first nine months of treatment, and whether mREE per kilogram fat free mass (mREE/kgFFM) differs across patients with different body composition profiles. Finally, we compared mREE to predicted REE (pREE) by the Schofield equation to determine whether the Schofield equation adequately reflects REE in children with cancer.
Methods:
Seventy-six children with cancer were included in this longitudinal study. mREE was measured using indirect calorimetry at 6-11 weeks (T0), 12-23 weeks (T1) and 24-36 weeks (T2) after diagnosis. Differences in mREE/kgFFM between time points were analyzed using the Wilcoxon signed-rank test. Linear regression models were conducted to explore the association between age, sex or tumor type and mREE/kgFFM. To examine whether the distribution of mREE/kgFFM varied across body composition categories, the Kruskal-Wallis test was employed. Differences between mREE and pREE were analyzed using the Wilcoxon signed-rank test. Agreement between mREE and pREE was assessed with Bland-Altman plots.
Results:
At T0, T1 and T2, median (Q1-Q3) mREE (kcal/kgFFM/day) was 35.8 (26.8-44.9), 40.3 (32.2-48.4) and 46.0 (38.0-54.0), respectively. Across the three time points, there were no significant differences in mREE/kgFFM. Age (β = -2.07, 95% CI [-2.52,-1.62]), but not sex or tumor type, was inversely associated with mREE/kgFFM. There was no significant difference in distribution of mREE/kgFFM across body composition categories. mREE was significantly different from pREE at T0 and T1, but not at T2. Mean differences (kcal/day) with corresponding 95% limits of agreement for T0, T1 and T2 were -55 kcal/day (-321-212), -72 kcal/day (-410- 267) and -52 kcal/day (-452-348), respectively.
Conclusion:
In this study, REE did not change during treatment in children with cancer. Furthermore, mREE/kgFFM was not associated with tumor type and did not differ significantly across patients with varying body composition profiles. Finally, the Schofield equation should be used with caution in this population, as individual-level differences compared to mREE may be clinically relevant.
