Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma

Abstract

BACKGROUND The diagnosis of malnutrition in patients with independent hepatocellular carcinoma (HCC) varies from 20% to 50%, is related to important complications and has a direct impact on the prognosis. Determination of the resting energy expenditure (REE) has become an important parameter in this population, as it allows therapeutic adjustments to recover their nutritional status. The REE in cirrhosis, with and without HCC, is not clearly defined, and requires the identification and definition of the best nutritional approach. AIM To evaluate the REE of patients with cirrhosis, with and without HCC. METHODS This is a prospective observational study evaluating the REE of 118 patients, 33 with cirrhosis and hepatocellular carcinoma and a control group of 85 patients with cirrhosis without HCC, using indirect calorimetry (IC), bioimpedance, and predictive formulas. RESULTS The REE determined by IC in cirrhotic patients with HCC was 1643 ± 364 and in those without HCC was 1526 ± 277 ( P = 0.064). The REE value as assessed by bioimpedance was 1529 ± 501 for those with HCC and 1660 ± 385 for those without HCC ( P = 0.136). When comparing the values of REE determined by IC and predictive formulas in cirrhotics with HCC, it was observed that only the formulas of the Food and Agriculture Organization (FAO)/World Health Organization (WHO) (1985) and Cunningham (1980) presented values similar to those determined by IC. When comparing the REE values determined by IC and predictive formulas in cirrhotics without HCC, it was observed that the formulas of Schofield (1985), FAO/WHO (1985), WHO (2000), Institute of Medicine (IOM) (2005) and Katch and McArdie (1996) presented values similar to those determined by IC. CONCLUSION The FAO/WHO formula (1985) could be used for cirrhotic patients with or without HCC; as it is the one with the values closest to those obtained by IC in these cirrhotic patients.

Assessment of resting energy expenditure in patients with cirrhosis

“…Data from the electronic medical records of the patients, related to the diagnosis, staging by the Child-Pugh score, age, and sex of the participants, were collected. The diagnosis of cirrhosis was made by clinical, laboratory, imaging, and/or, eventually, liver biopsy in accordance with the hospital liver transplant group standards[ 12 ].…”

“…Different studies show that protein degradation is measured by increased oxygen consumption through indirect calorimetry (IC), where an increase in resting energy expenditure (REE) is observed in 35% of people with cirrhosis compared to the healthy population[ 9 - 11 ]. This conflict could be explained by several confounding factors, such as the use of medication, the patient’s body composition, and the presence of comorbidities[ 12 ]. However, the current literature is still conflicting regarding the relationship between cirrhosis progression and RMR alterations.…”