结直肠癌患者的总能量消耗：与身体成分、身体活动和能量推荐的关系。
Total energy expenditure in patients with colorectal cancer: associations with body composition, physical activity, and energy recommendations.
机构信息
Division of Human Nutrition, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
出版信息
Am J Clin Nutr. 2019 Aug 1;110(2):367-376. doi: 10.1093/ajcn/nqz112.
BACKGROUND
Total energy expenditure (TEE) data in patients with early-stage cancer are scarce, precluding an understanding of energy requirements.
OBJECTIVE
The objective was to cross-sectionally characterize TEE in patients with colorectal cancer (CRC) and to compare measured TEE with energy recommendations. It was hypothesized that TEE would differ according to body mass, body composition, and physical activity level (PAL) and current energy recommendations would have poor individual-level accuracy.
METHODS
Patients with newly diagnosed CRC had resting energy expenditure (REE) measured by indirect calorimetry and TEE by doubly labeled water. Hypermetabolism was defined as REE > 110% of that predicted from the Mifflin St.-Jeor equation. Body composition was assessed via DXA. Physical activity was determined as the ratio of TEE to REE (TEE:REE) (PAL) and residual activity energy expenditure (RAEE). TEE was compared with energy recommendations of 25-30 kcal/d and Dietary Reference Intakes (DRIs) using Bland-Altman analyses. Patients were stratified according to median BMI, PAL, and sex-specific ratio of fat mass (FM) to fat-free mass (FFM).
RESULTS
Twenty-one patients (M:F 14:7; mean ± SD BMI: 28.3 ± 4.9 kg/m2, age: 57 ± 12 y) were included. Most (n = 20) had stage II-III disease; 1 had stage IV. Approximately half (n = 11) were hypermetabolic; TEE was not different in those with hypermetabolism and REE as a percentage of predicted was not correlated with TEE. Mean ± SD TEE was 2473 ± 499 kcal/d (range: 1562-3622 kcal/d), or 29.7 ± 6.3 kcal/kg body weight (range: 20.4-48.5 kcal/kg body weight). Mean ± SD PAL was 1.43 ± 0.27. The energy recommendation of 25 kcal/kg underestimated TEE (-12.6% ± 16.5%, P = 0.002); all energy recommendations had wide limits of agreement (the smallest was DRI with measured PAL: -21.2% to 29.3%). Patients with higher BMI and FM:FFM had higher bias using kilocalories per kilogram recommendations; bias from several recommendations was frequently lower (i.e. underestimation) in patients with higher PAL and RAEE.
CONCLUSIONS
TEE variability was not reflected in energy recommendations and error was related to body weight, body composition, and physical activity. This trial was registered at clinicaltrials.gov as NCT03131921.
背景
早期癌症患者的总能量消耗（TEE）数据很少，因此无法了解能量需求。
目的
本研究旨在横截面上描述结直肠癌（CRC）患者的 TEE，并将测量的 TEE 与能量推荐值进行比较。假设 TEE 会根据体重、身体成分和体力活动水平（PAL）而有所不同，并且当前的能量推荐值在个体水平上的准确性较差。
方法
新诊断为 CRC 的患者通过间接测热法测量静息能量消耗（REE），并通过双标记水法测量 TEE。REE 超过 Mifflin-St.-Jeor 方程预测值的 110%被定义为高代谢。通过 DXA 评估身体成分。通过 TEE 与 REE 的比值（TEE:REE）（PAL）和剩余活动能量消耗（RAEE）来确定体力活动。使用 Bland-Altman 分析将 TEE 与 25-30 kcal/d 的能量推荐值和膳食参考摄入量（DRIs）进行比较。根据中位数 BMI、PAL 和性别特异性脂肪量（FM）与去脂体重（FFM）的比值，将患者分层。
结果
共纳入 21 名患者（男：女 14:7；平均 BMI ± SD：28.3 ± 4.9 kg/m2，年龄：57 ± 12 岁）。大多数（n=20）患有 II-III 期疾病；1 例为 IV 期。约一半（n=11）为高代谢；高代谢患者的 TEE 无差异，REE 作为预测值的百分比与 TEE 不相关。平均 TEE ± SD 为 2473 ± 499 kcal/d（范围：1562-3622 kcal/d），或 29.7 ± 6.3 kcal/kg 体重（范围：20.4-48.5 kcal/kg 体重）。平均 PAL ± SD 为 1.43 ± 0.27。25 kcal/kg 的能量推荐值低估了 TEE（-12.6%±16.5%，P=0.002）；所有能量推荐值的一致性界限都很宽（最小的是用实测 PAL 表示的 DRIs：-21.2%至 29.3%）。BMI 和 FM:FFM 较高的患者使用每公斤千卡的推荐值时，偏差较大；在 PAL 和 RAEE 较高的患者中，来自几种推荐值的偏差常常较低（即低估）。
结论
TEE 的变异性没有反映在能量推荐值中，误差与体重、身体成分和体力活动有关。本研究在 clinicaltrials.gov 注册为 NCT03131921。
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