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Energy expenditure in patients with hepatocellular carcinoma
1Department of Surgery, College of Medicine, National Taiwan University, Taipei, Republic of China.
Background:
An increase in resting energy expenditure (REE) is considered to contribute to the weight loss experienced by patients with cancer. However, alternations in basal metabolism vary among patients with different neoplasms. REE in patients with hepatocellular carcinoma (HCC), a common malignant tumor in Taiwan, was evaluated.
Methods:
Fifty-seven male patients with HCC and 60 male control subjects without known cancer were entered in the study. The groups did not differ significantly in age, body weight, and height. Indirect calorimetry was used to measure REE. Oxidative rates of endogenous substrates also were calculated.
Results:
REE was significantly higher in the HCC group than the control group (22.12 +/- 0.36 kcal/kg/day versus 20.99 +/- 0.27 kcal/kg/day, P < 0.05; and 115.3 +/- 4.3 kcal/100 mg creatinine versus 102.2 +/- 3.8 kcal/100 mg creatinine, P < 0.05). A higher measured-to-predicted-REE ratio also was observed in the HCC group (101.5% +/- 1.4% versus 93.6% +/- 1.0%; P < 0.005). REE in patients with HCC did not differ according to whether patients had liver cirrhosis or ascites. In addition, REE of patients with large and medium tumors were higher than were those of patients with small tumors, but no difference was found between the REE of patients with small tumors and the control subjects. Also observed were an increase in oxidation of fat with a decrease in oxidation of protein in patients with HCC and a relative decrease in the contribution of fat with an increase in the contribution of carbohydrates to REE after the increase of tumor size.
Conclusions:
The results suggest that patients with HCC are hypermetabolic and the elevation in REE is related to tumor size, not to the presence of liver cirrhosis or ascites.