Hypermetabolism: should cancer types, pathological stages and races be considered in assessing metabolism and could elevated resting energy expenditure be the therapeutic target in patients with advanced cancer?

Alternatively Activated Macrophages Drive Browning of White Adipose Tissue in Burns

“…H ypermetabolism is a debilitating and complex pathologic response but commonly observed in individuals with advanced cancer, burns, and heart disease. [1][2][3] Significant catabolism, insulin resistance with hyperglycemia, lipolysis, hyperinflammation, and organ dysfunction characterize this hypermetabolic response. [4][5][6] Persistent and exaggerated hypermetabolism contributes to increased morbidity and mortality.…”

Home Artificial Nutrition and Energy Balance in Cancer Patients: Nutritional and Clinical Outcomes

“…Hypermetabolism, more than 10% of REE, is characterized by an increase in the body’s basal metabolic rate, and is present in more than 50% of cancer patients [ 41 ]. The energy requirements of the neoplastic mass, the development of a chronic systemic inflammatory state in the host, and the production of lipid mobilizing factors and proteolysis inducing factors by cancer itself [ 21 , 42 ] increase the energy and protein catabolism and cause a higher degree of malnutrition than that due only to the reduction of oral food intake, compromising the expected response to the artificial nutrition [ 43 ].…”

“…In this context, the correct assessment of energy requirement becomes a crucial step in choosing the type and composition of the nutritional therapy. Several studies [ 42 , 43 , 44 , 45 , 46 ] emphasize the importance of indirect calorimetry as the goal standard in evaluating the real energy requirements in cancer patients. Predictive formulas, such as the Harris–Benedict equation, do not consider the cancer energy expenditure, underestimating the real REE of the patient [ 47 ].…”

Determining the factors affecting energy metabolism and energy requirement in cancer patients

“…Hypermetabolism is defined as the increase in REE. [ 65 ] When evaluated in terms of the cancer type, normal rate of REE was observed in patients with breast, melanoma, gastric, or colorectal cancer in some studies,[ 39 66 ] while hypermetabolism was seen in patients with pancreatic or lung cancer. [ 66 ] In addition, in studies in which REE was evaluated by indirect calorimetry, it was reported that 57% of the 140 patients with head and neck cancer[ 67 ] and 56.9% of 109 patients with advanced gastrointestinal cancer[ 68 ] were hypermetabolic and most were malnourished.…”