Better assessment of energy requirements needed in CRC patients

Using 30 kcal/kg to predict energy requirements overestimates total energy expenditure (TEE) by 1.44 times in patients with colorectal cancer (CRC) in a controlled sedentary environment, as shown in a study. In addition, TEE is outside of the predicted requirement range for most.

“This is the largest study to assess TEE of patients with cancer using whole-room indirect calorimeter and highlights the need for improved assessment of energy requirements in this population,” the researchers said.

Thirty-one patients with stages II‒IV CRC (mean age 56 years, body mass index [BMI] 27.9 kg/m², 68 percent male) from the Protein Recommendation to Increase Muscle (PRIMe) trial were included in this cross-sectional study.

The researchers assessed TEE by 24-h stay in a whole-room indirect calorimeter before dietary intervention and compared this with cancer-specific predicted energy requirements (25‒30 kcal/kg). Generalized models, paired-samples t tests, and Pearson correlation were used.

Higher absolute TEE was observed in males (mean difference [MD], 391 kcal/d, 95 percent confidence interval [CI], 167‒616; p<0.001), patients with colon cancer (MD, 279 kcal/d, 95 percent CI, 73‒485; p=0.010), and patients with obesity (MD, 393 kcal/d, 95 percent CI, 182‒604; p<0.001).

When adjusted for sex, appendicular lean soft tissue (β, 46.72, 95 percent CI, 34.17‒59.17; p<0.001) and tumour location (colon: β, 139.69, 95 percent CI, 19.44‒259.95; p=0.023) independently predicted TEE.

Notably, patients with obesity had higher error between measured TEE and energy requirements predicted by 25 kcal/kg (MD, 241 kcal/d, 95 percent CI, 76‒405; p=0.010) or 30 kcal/kg (MD, 367 kcal/d, 95 percent CI, 163‒571; p<0.001). In addition, there were proportional errors noted (25 kcal/kg: r, ‒0.587; p<0.001; 30 kcal/kg: r, ‒0.751; p<0.001).

TEE (MD, 25 kcal/kg, 95 percent CI, 24‒27) was below predicted energy requirements when using 30 kcal/kg (‒430 kcal/d; p<0.001).

“Special considerations are warranted when determining TEE of patients with colorectal cancer, such as BMI, body composition, and tumour location.