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Basal Energy Expenditure measured by indirect calorimetry in patients with squamous cell carcinoma of the esophagus. The authors would like to acknowledge the Research Incentive Fund of the Hospital de Clinicas de Porto Alegre, the financial incentive.

Determination of Basal Energy Expenditure BEE is essential for planning nutritional therapy in patients with esophageal cancer. Cross-sectional study involving 30 patients admitted with a diagnosis of SCC who underwent IC before starting cancer therapy. Nutritional assessment was conducted using anthropometric parameters body mass index, arm circumference, triceps skinfold thickness, arm muscle circumference, and weight lossbiochemical parameters albumin, transferrin and C-reactive protein and tetrapolar bioimpedance to assess body composition fat free mass.

Additionally, lung capacity was measured and clinical staging of the cancer established by the TNM method.

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Therefore, despite the practical difficulties of implementing IC, its use should be considered. Indirect calorimetry IC is calrimetria noninvasive method for determining energy needs from the gas exchanges that takes place between the body and the environment, namely, the volume of oxygen consumed VO 2indirectta major component of BEE, and the volume of carbon dioxide produced VCO 2.

This is obtained by analysis of air inhaled and exhaled by the lungs Prediction equations are used to establish a standard that will serve as a benchmark for the comparison of BEE in sick individuals. Measurement calorimrtria BEE in healthy individuals, and also for different groups of diseases is essential for proper planning of nutritional therapy 5with the purpose of avoiding the detrimental effects caused by both over and under eating 6.

The objective of this study was to determine by IC the BEE of patients diagnosed with squamous cell carcinoma of the esophagus SCC and to compare these findings with other parameters that make up a jndirecta assessment.

The population studied consisted of 30 adult patients with a diagnosis confirmed by pathological examination of SCC, attending the group of gastrointestinal surgery, Hospital de Clinicas, Porto Alegre, from April until June The exclusion criteria were: These criteria sought to exclude any clinical condition that might interfere with energy expenditure. The study was approved indirevta the Research Ethics Committee of our institution and all participants signed a consent form.

Patients underwent a nutritional assessment upon admission in order to determine their nutritional status.

Calorimetria Indirecta by Ethel Muñiz on Prezi

The following measurements were recorded: Venous blood was sampled for levels of: Clinical staging of the disease was determined by the TNM classification of malignant tumors Patient lung capacity was also determined through spirometry and using the Tiffeneau Index reference value: Participants were instructed to fast for 8 hours prior to the procedure, and in addition, to take no part in physical activity from the day before the exam until the procedure was completed 9.


Patients were at rest for 30 minutes before data collection commenced. The system was calibrated in accordance with the instruction manual before each measurement.

Oxygen consumption and carbon dioxide production were measured with the patient being in a supine position over a period of 25 minutes including the initial time of 5 minutes. The equation as described by Weir 10 uses the last 20 minutes, after having first observed an initial 5 minute resting steady state, with the mean being multiplied by 1.

An additional method for prediction was included based on recommendations for the use of an injury factor for cancer of 1. Quantitative variables were described through mean and standard deviation, except for measurement of CRP for which the median and range of variation were used. Categorical variables were described using absolute and relative frequencies.

Student’s t-test for independent samples was used to compare continuous variables according to group. Energy expenditure measured by IC was compared to values gained through estimation methods using Student’s t-test for paired samples.

When adjusted for FFM the analysis of covariance was applied. The Bland-Altman method was used for assessing agreement between the findings. Pearson’s chi-square test was applied to assess associations between categorical variables, and Pearson’s correlation analysis when assessing associations between continuous variables.


The multiple linear regression model with backward elimination was used to control confounding factors. The Cochran test was used to compare methods of nutritional assessment. In the case of statistical significance, the McNemar test was applied to locate the difference. In relation to BMI, 8 patients Anorexia was reported by 7 Dysphagia related to solid and soft foods was present in 23 Patient characteristics are described in table I.

According indirectaa the classification of Boothby et al Cxlorimetria significant difference was found in the BEE between malnourished In relation to transferrin in malnourished patients the BEE was The mean for albumin was 4. The median for the 16 patients who presented alterations in CRP was A multiple linear regression analysis was performed to evaluate independent factors associated with BEE measured by IC.

Many studies in recent decades have investigated energy expenditure in cancer patients with some maintaining the idea that these patients have a high BEE which significantly contributes to the development of malnutrition 14while others have found no change Research by Reeves 16which looked at post-radiotherapy patients with lung calorimetrja gastrointestinal tract cancers found the mean BEE measured by IC to be A further study by Thomson 17 involving only black patients with esophageal cancer found the mean BEE measured by IC caloriimetria In a study by Knox 20 which evaluated malnourished patients with cancer gastrointestinal and gynecologicalthe BEE estimated by the HBE showed no statistically significant differences when compared to the BEE as measured by IC.

The difference we found of 7. In this study the HBE with an injury factor of 1. In the study by Johnson 22 using the HBE with a correction factor of 1. Other research calorimstria Cao 23 involving recently diagnosed cancer patients esophagus, stomach, colorectal and pancreatic produced results of 7. Body size as defined by height and ca,orimetria is an important determinant of BEE, although it is difficult to separate the specific effect of each factor 26, Weight loss in patients initially occurs as a fat loss with this resulting in an observed increase in FFM.


Any such underestimation could be of clinical importance as underestimating the energy needs of a patient could impact on the effect of the calotimetria therapy 29, The study by Cao 23 demonstrated that cancer patients lose body fat more rapidly than FFM, which could be a possible mechanism for the increase in BEE as FFM is more metabolically active than fat.

The role of CRP as a predictor of survival has been demonstrated for different tumor types In the study by Johnson 22CRP was increased in cancer patients who had had a significant weight loss and suffered from cancer cachexia syndrome, with the BEE for these patients also showing increases. The reason for this discrepancy with our results may be that the patients evaluated by Johnson 22 had cancer cachexia syndrome, which could mean that other factors may have influenced the increase in BEE, whereas in our study the cause of significant weight loss for the majority of patients was due to the obstructive nature dysphagia of the tumor, and not cancer cachexia syndrome.

In patients with cancer the acute phase caloorimetria may contribute to an increased BEE 32which can promote weight loss The IF is indurecta as an index sensitive to mild airway obstruction It should be noted that it was not possible to evaluate the IF of 4 patients, and of the others, only 4 had an altered IF. Dempsey et al The use of IC should always be considered since it is the “gold standard” method for determining BEE.

However, even today the use of IC is not routine and thus further studies involving larger numbers of patients with SCC are necessary in order to identify the ideal injury factor to be used with the HBE, for those occasions when IC is not available.

Food and Nutrition Board, Dietary reference intakes for energy. National Academy Press; The measurement of energy expenditure: Respir Care ; Am J Physiol ; The Harris-Benedict studies jndirecta human basal metabolism: J Am Diet Assoc ; 98 4: Changing concepts of nutrient requirements in disease: Are patients fed appropriately according to their caloric requirements?

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J Physiology ; Biometric studies of basal metabolism in man. Metabolic response to injury and illness: Studies of the energy of metabolism of normal individuals: Am J Physiol The effect of gastrointestinal malignancy on resting metabolic expenditure.

Br J Surg ; 69 8: Lancet ; 2 Resting energy expenditure in patients with solid tumors undergoing anticancer therapy. Nutrition ; 22 6: Resting metabolic rate of esophageal carcinoma patients: A model for energy expenditure measurement in a homogenous cancer population.

JPEN ; 14 2: A new predictive equation for resting energy expenditure in healthy indirrcta. Am J Clin Nutr ; Roza AM, Shizgal H. The Harris Benedict equation calorietria Energy expenditure in malnourished cancer patients.