がん悪液質高齢者のエネルギー必要量

がん悪液質の高齢者におけるエネルギー必要量に関する研究です。

Marc Bennefoy, et al: Energy requirement in elderly cachectic patients with cancer

59人の高齢がん患者（平均年齢76.88歳）を対象に、がん悪液質の診断にはFearonらの国際コンセンサス分類を用いています。間接熱量計で測定したエネルギー消費量とHarris-Benedict式で計算したエネルギー消費量を比較しました。

結果ですが、平均体重57.86kg、過去6か月の体重減少は平均7.13kg、平均BMIは21.93、平均血清アルブミン値は3.07g/dl、平均CRPは3.6mg/dl、平均MNA得点は17.68でした。間接熱量計での平均は1296kcal、Harris-Benedict式での平均は1135kcalでした。

31.7％の患者で間接熱量計での数値はHarris-Benedict式より20％以上高かったです。1日エネルギー摂取量の平均は1361kcal、23.52 kcal/kg/dayで、食思不振は43％に認めました。

これよりHarris-Benedict式ではエネルギー消費量が低めにでるという結論です。また、。少なくとも安静時エネルギー消費量の1.4倍の摂取量が必要と推定されることより、体重減少の主要因はエネルギー摂取量が少ないことと推測しています。

日本では高齢者のエネルギー消費量をHarris-Benedict式で計算すると高すぎると言われていますが、がん悪液質で平均CRPは3.6mg/dlとかなりの全身炎症を認める高齢者ではむしろ低すぎるという話です。ただストレス係数として1.15をかければ、間接熱量計の数値に近付きます。

Background: Cachexia is a well-known adverse effect of cancer and is associated with poor prognosis, impaired physical function and reduced tolerance to anticancer treatments. Despite understanding of cachexia has progressed, the clinical management remains complex and few data about energy requirement is available in elderly patients with cancer cachexia despite its implication for nutritional support.

Aims: The present study evaluated measured resting energy expenditure (mREE) and predicted energy expenditure (pREE) in elderly patients with cancer cachexia.

Methods: Fifty-nine elderly patients from our consultation of nutrition and addressed by the service of oncology were consecutively included (76.88 ± 9.17 years). They all had weight loss >5% or BMI < 20 and weight loss >2%, over the past 6 months according to Fearon’s criteria. mREE was measured with indirect calorimetry and pREE was calculated from the Harris and Benedict equations.

Results: Mean weight was 57.86 ± 12.88 kg and mean weight loss was 7.13 kg ± 3.46 at 6 months; mean BMI was 21.93 ± 4.25; mean albuminemia: 30.71 ± 7.19 g/l and CRP 35.96 ± 40.07 mg/l. Mean MNA score was 17.68 ± 4.87. mREE was 1,296.57 ± 341.11 kcal/day and pREE was 1,135.07 ± 199.13 kcal/day. Of the patients, 31.7% showed mREE more than 20% pREE; while caloric intake was 1,361 kcal ± 572/day and 23.52 kcal/kg/day. Anorexia was present in 43% of the patients.

Conclusion: As expected, patients had inflammatory process and malnutrition criteria. Elderly patients with cancer cachexia show rather similar values for mREE and pREE that do not really confirm an elevated REE in the majority of our patients as commonly held. Loss of weight seems to be mainly explained by insufficient caloric intake since caloric intake was largely under energy requirement that may be estimated at least at 1.4 REE in these patients.