Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma

Ana Cristhina Henz; Claudio Augusto Marroni; Daniella Miranda da Silva; Joise Munari Teixeira; Thiago Thomé Silveira; Shaiane Ferreira; Andresa Thomé Silveira; Natalia Perin Schmidt; Jessica Taina Stein; Roberta Goulart Rayn; Sabrina Alves Fernandes

doi:10.4292/wjgpt.v12.i1.1

Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma

World J Gastrointest Pharmacol Ther. 2021 Jan 5;12(1):1-12. doi: 10.4292/wjgpt.v12.i1.1.

Affiliations

¹ Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil.
² Department of Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760470, RS, Brazil.
³ Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil.
⁴ Postgraduate Program in Medicine, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil.
⁵ Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil.
⁶ Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil. sabrinaafernandes@gmail.com.

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.

Keywords: Calorimetry; Carcinoma; Hepatocellular; Indirect; Liver cirrhosis; Rest energy expenditure.