Energy requirements in patients with upper gastrointestinal cancer prior to radical surgery as assessed by indirect calorimetry

Abstract

BACKGROUND: Nutritional support (NS) is an essential component of prehabilitation before surgical intervention in cancer patients with upper gastrointestinal (GI) tract cancer who have completed neoadjuvant chemotherapy (NACT). However, their actual energy requirements remain poorly understood.

AIM: The work aimed to determine energy requirements using indirect calorimetry (IC) in patients with malignant tumors of the upper GI tract who had completed NACT and were scheduled for radical surgical intervention.

METHODS: This observational, cross-sectional, single-center study included patients with upper GI tract cancer who completed NACT and were scheduled for radical surgery. Upon admission, body weight and height were measured. Body mass index (BMI) and weight loss over the preceding six months (as % of usual body weight) were calculated. Energy requirements were assessed via IC and also calculated using the Harris–Benedict equation with stress factors. The degree of protein-energy malnutrition (PEM) was classified according to GLIM criteria. Daily energy intake was calculated. Statistical analysis was performed using Microsoft Excel 2011. Data are presented as Me [Q1; Q3].

RESULTS: A total of 42 patients (24 males) were assessed; median age was 64 years [57; 72]. Esophageal cancer was diagnosed in 26 patients (61.9%), gastric cancer in 16 (38.1%). Median 6-month weight loss was 11.53% [8.62; 20.04], BMI was 24 [19.5; 26.88] kg/m². IC-based basal metabolic rate (BMR) was 1485.5 [1327.75; 1622.25] kcal/day; actual energy requirement (AER) was 1960.86 [1752.63; 2141.37] kcal/day, or 28.37 [26.23; 32.78] kcal/kg. According to the Harris–Benedict equation, BMR was 1391.43 [1264.22; 1525.49] kcal/day, AER was 1836.69 [1668.78; 2013.64] kcal/day, or 27.35 [25.73; 30.24] kcal/kg. Caloric intake was 1232.00 [967.00; 1479.25] kcal/day, or 18.91 [15.90; 21.18] kcal/kg. The IC method yielded greater variability compared to calculated estimates. Moderate PEM was diagnosed in 15 patients (35.7%), and severe PEM in 27 (64.3%).

CONCLUSION: Patients with upper GI tract cancer who have undergone NACT present with PEM, the primary diagnostic criterion being unintentional weight loss over the preceding six months. IC-based BMR measurements provide more individualized results than those derived from the Harris–Benedict equation.

Keywords

prehabilitation / nutritional support / indirect calorimetry / energy requirements / respiratory quotient

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