Resting energy expenditure and body composition in patients with head and neck cancer: An observational study leading to a new predictive equation

Objectives: Patients with head and neck cancer have changes in body composition and resting energy expenditure (REE) related to significant inflammatory processes. We investigated REE and body composition in a population of patients with head and neck cancer, comparing the measured REE with predicted energy expenditure and deriving an equation of anthropometric values and body composition. Methods: This retrospective, observational, descriptive study of a single center included patients with head and neck cancer. We evaluated nutritional status by body mass index (BMI) and Patient Generated Subjective Global Assessment (PG-SGA), body composition by electric bioimpedance, and REE by indirect calorimetry (IC). Results: We included 140 patients, most of whom were men (80.7%), 60 y or older (58.6%), and had advanced disease (77.9%). Most were malnourished by BMI standards (77.9%) and severely malnourished according to the PG-SGA (49.3%), with a fat-free mass below the ideal values (82.9%) associated with sarcopenia (92.1%). Hypermetabolism was 57%. When comparing REE with the Harris-Benedict formula, we found the agreement limits from -546 613 to 240 708, the mean difference was -152 953 (95% confidence interval [CI], -185 844 to -120 062) and Pitman's variance test was r = -0.294 (P = 0.001). When we included the activity factor and the thermogenesis factor in REE and compared with Harris-Benedict, we found the agreement limits from -764.423 to 337.087, a mean difference of -213.668 (95% CI -259.684 to -167.652), and the Pitman's variance text at r = -0.292 (P = 0.001). Conclusion: Predictive equations, generally recommended by guidelines, are imprecise when compared with IC measures. Therefore, we suggest a new predictive equation. (C) 2018 Elsevier Inc. All rights reserved.