Total energy expenditure in patients with colorectal cancer: associations with body composition, physical activity, and energy recommendations

Background: Total energy expenditure (TEE) data in patients with early-stage cancer are scarce, precluding an understanding of energy requirements. Objective: The objective was to cross-sectionally characterize TEE in patients with colorectal cancer (CRC) and to compare measured TEE with energy recommendations. It was hypothesized that TEE would differ according to body mass, body composition, and physical activity level (PAL) and current energy recommendations would have poor individual-level accuracy. Methods: Patients with newly diagnosed CRC had resting energy expenditure (REE) measured by indirect calorimetry and TEE by doubly labeled water. Hypermetabolism was defined as REE> 110% of that predicted from the Mifflin St.-Jeor equation. Body composition was assessed via DXA. Physical activity was determined as the ratio of TEE to REE (TEE: REE) (PAL) and residual activity energy expenditure (RAEE). TEE was compared with energy recommendations of 25-30 kcal/d and Dietary Reference Intakes (DRIs) using Bland-Altman analyses. Patients were stratified according to median BMI, PAL, and sex-specific ratio of fat mass (FM) to fat-free mass (FFM). Results: Twenty-one patients (M:F 14: 7; mean +/- SD BMI: 28.3 +/- 4.9 kg/m(2), age: 57 +/- 12 y) were included. Most (n = 20) had stage II-III disease; 1 had stage IV. Approximately half (n = 11) were hypermetabolic; TEE was not different in those with hypermetabolism and REE as a percentage of predicted was not correlated with TEE. Mean +/- SD TEE was 2473 +/- 499 kcal/d (range: 1562-3622 kcal/d), or 29.7 +/- 6.3 kcal/kg body weight (range: 20.4-48.5 kcal/kg body weight). Mean +/- SD PAL was 1.43 +/- 0.27. The energy recommendation of 25 kcal/kg underestimated TEE (-12.6% +/- 16.5%, P = 0.002); all energy recommendations had wide limits of agreement (the smallest was DRI with measured PAL: -21.2% to 29.3%). Patients with higher BMI and FM: FFM had higher bias using kilocalories per kilogram recommendations; bias from several recommendations was frequently lower (i.e. underestimation) in patients with higher PAL and RAEE. Conclusions: TEE variability was not reflected in energy recommendations and error was related to body weight, body composition, and physical activity. This trial was registered at clinicaltrials.gov as NCT03131921.