Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Jan 5, 2021; 12(1): 1-12
Published online Jan 5, 2021. doi: 10.4292/wjgpt.v12.i1.1
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
Ana Cristhina Henz, Sabrina Alves Fernandes, Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil
Claudio Augusto Marroni, Department of Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760470, RS, Brazil
Daniella Miranda da Silva, Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
Joise Munari Teixeira, Postgraduate Program in Medicine, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
Thiago Thomé Silveira, Shaiane Ferreira, Andresa Thomé Silveira, Natalia Perin Schmidt, Jessica Taina Stein, Roberta Goulart Rayn, Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
Author contributions: Henz AC participated in the creation, elaboration, data collection, tabulation, statistical analysis and writing of the scientific article, Da Silva DM contributed to the creation, elaboration, tabulation, data collection and writing of the scientific article, Teixeira JM assisted in data collection, Silveira TT assisted in data collection, Ferreira S assisted in data collection, Silveira AT assisted in data collection, Schmidt NP assisted in data collection, Stein JT assisted in data collection, Rayn RG assisted in data collection, Marroni CA and Fernandes SA contributed to the creation, elaboration, data collection, tabulation, statistical analysis and writing and revision of the scientific article.
Institutional review board statement: This project was approved by the Research Ethics Committee of Irmandade Santa Casa de Misericórdia de Porto Alegre (number 2.387.800).
Informed consent statement: Patients who agreed to participate in the study signed an informed consent form.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest related to this article.
Data sharing statement: No additional data are available for sharing.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sabrina Alves Fernandes, PhD, Professor, Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil. sabrinaafernandes@gmail.com
Received: June 30, 2020
Peer-review started: June 30, 2020
First decision: September 12, 2020
Revised: September 26, 2020
Accepted: November 12, 2020
Article in press: November 12, 2020
Published online: January 5, 2021
ARTICLE HIGHLIGHTS
Research background

The diagnosis of malnutrition in patients with hepatocellular carcinoma (HCC) varies from 20% to 50%, as it is related to important complications and has a direct impact on 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 HCC is not clearly defined, and requires the identification and definition of the best nutritional approach.

Research motivation

The diagnosis of malnutrition in patients with HCC varies from 20% to 50%, is related to important complications and has a direct impact on prognosis. Determination of the REE has become an important parameter in this population, as it allows therapeutic adjustments to recover their nutritional status. The REE in HCC is not clearly defined, and the identification and definition of the best nutritional approach is necessary.

Research objectives

The aim of this study is to evaluate the REE of patients with cirrhosis, with and without HCC, measured by IC and to compare these values with those obtained by bioimpedance (BIA) and predictive formulas, in order to identify which is the best method of evaluation.

Research methods

This prospective observational study included 118 patients, aged ≥ 18 years, of both sexes, divided into two groups. One group consisted of 33 cirrhotic patients with HCC and a control group of 85 cirrhotics without HCC, attending the Department of Gastroenterology and Liver Transplantation of Irmandade da Santa Casa de Misericórdia de Porto Alegre, RS, Brazil, from March 2017 to August 2018. Quantitative variables were described by mean and standard deviation and categorical variables by absolute and relative frequencies.

Research results

The REE determined by indirect calorimetry (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 BIA was 1529 ± 501 for those with HCC and was 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 FAO/WHO (1985) and Cunningham (1980) presented values similar to those determined by IC. When comparing the REE values determined by the IC and predictive formulas in cirrhotics without HCC, it was observed that the formulas of Schofield (1985), FAO/WHO (1985), WHO (2000), IOM (2005) and Katch and McArdie (1996) presented values similar to those determined by IC.

Research conclusions

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 assessed by BIA 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 FAO/WHO (1985) and Cunningham (1980) presented values similar to those determined by IC. When comparing the REE values determined by the IC and predictive formulas in cirrhotics without HCC, it was observed that the formulas of Schofield (1985), FAO/WHO (1985), WHO (2000), IOM (2005) and Katch and McArdie (1996) presented values similar to those determined by IC.

Research perspectives

The REE as assessed by IC in cirrhotics with and without HCC was similar. When comparing the IC values with those of the BIA, we found that in patients with HCC, the values were similar. The values estimated by the predictive formulas were very erratic and disparate, when compared to IC. The FAO/WHO formula could be used for those with or without HCC; the Cunningham formula in those without HCC and the McArdle in those with HCC, as they are the ones with the closest values to those obtained by IC in these cirrhotic patients. Apparently, the presence of HCC in cirrhotics does not appear to significantly alter the REE.