Relation between hypermetabolism, cachexia, and survival in cancer patients: a prospective study in 390 cancer patients before initiation of anticancer therapy ,

Abstract

Cachexia is a major cause of death in cancer patients. The role of hypermetabolism in cancer cachexia remains unclear. We studied the relation between resting energy expenditure (REE), the estimated energy balance, clinical and biological markers of cachexia, and survival. REE was measured with the use of indirect calorimetry in cancer patients before the initiation of anticancer therapies. Hypermetabolic, normometabolic, and hypometabolic patients were identified with the use of Boothby's standard. Weight loss, performance status (PS), C-reactive protein (CRP), albumin, the nutritional risk index, daily energy intake, energy balance (equal to daily energy intakes minus the REE), and survival were recorded. Of 390 enrolled patients, 49% of subjects were hypermetabolic, 30% of subjects were normometabolic, and 21% of subjects were hypometabolic. Mean daily energy intakes did not differ significantly between the 3 groups. Hypermetabolic patients, compared with normometabolic patients, were more likely to have a negative energy balance [45% compared with 32%, respectively; OR: 1.74 (95% CI: 1.05, 2.91); = 0.024], weight loss>5% [48% compared with 34%, respectively; OR: 1.83 (95% CI: 1.11, 3.04); = 0.013], PS ≥2 [40% compared with 29%, respectively; OR: 1.70 (95% CI: 1.01, 2.88); = 0.038], and CRP concentrations ≥10 mg/L [52% compared with 33%, respectively; OR: 2.2 (95% CI: 1.33, 3.66); = 0.001]. In metastatic patients, compared with normometabolism, hypermetabolism was associated with a reduced median survival [14.6 compared with 21.4 mo, respectively; OR: 1.48 (95% CI: 1.01, 2.17); = 0.044]. Hypermetabolism is correlated with clinical and biological markers of cancer cachexia and is associated with a shorter survival in metastatic cancer patients. The development of therapeutic strategies that aim to blunt hypermetabolism appears warranted. This trial was registered at www.controlled-trials.com as ISRCTN46152275.

A randomized trial of adjunct testosterone for cancer‐related muscle loss in men and women

“…At baseline REE testing, three testosterone and two placebo patients were hypermetabolic with REE values more than 110% of predicted, and two testosterone and two placebo patients were hypometabolic with REE values <90% of predicted . Average baseline REE was not significantly different from predicted REE based on body weight, age, height, and gender for the placebo (1409 kcal/day, P = 0.55) or testosterone (1286 kcal/day, P = 0.80) groups ( Table ).…”

“…Predicted REE (pREE) was also determined using the Harris–Benedict equations based on each patient's pre‐treatment weight, age, height, and gender. Patients were considered hypometabolic if pre‐treatment REE was <90% of predicted, and hypermetabolic if pre‐treatment REE was more than 110% of predicted . Paired t ‐tests were used to compare mREE with pREE.…”

“…Patients were considered hypometabolic if pre-treatment REE was <90% of predicted, and hypermetabolic if pre-treatment REE was more than 110% of predicted. 27 Paired t-tests were used to compare mREE with pREE.…”

Energy metabolism in amyotrophic lateral sclerosis: assessment of body composition and energy expenditure

“…It has recently been shown that hypermetabolism correlates with clinical and biological markers of cancer cachexia and is associated with a shorter survival in metastatic cancer patients (Vazeille et al, 2017). Hypermetabolism in patients with severe sepsis in ICU predicts a worse mortality (Wu et al, 2015a).…”

“…Although a causal relationship between hypermetabolism and survival has not been confirmed in ALS, hypermetabolism is known to predict a shorter survival in other disorders including cancer (Vazeille et al, 2017), sepsis (Wu et al, 2015a) and burns (Herndon et al, 2001). Evidence from dietary studies in ALS suggests that hypermetabolism and survival could be linked.…”