The impact of home enteral nutrition planned with the use of indirect calorimetry on the nutritional status and body composition of cancer patients

Abstract

Background

Studies show that malnutrition is common among cancer patients, ranging from about 20% to more than 70%. It is known that malnutrition that is not managed properly worsens the course of the disease, prolongs the hospital stay, and impacts the quality of life and treatment toxicities. Malnutrition has many negative effects, therefore individualization and optimization of nutritional support is crucial for the patient's health. This study aimed to assess the impact of home enteral nutrition (HEN) planned with the use of indirect calorimetry on the nutritional status and body composition of cancer patients.

Methods

This prospective, observational study included 28 patients with cancer recruited at the Nutrition Clinic of Department of General, Gastroenterologic and Oncologic Surgery, of the Medical University of Warsaw from December 2021 to December 2022. All patients were supported with HEN setup based on individual caloric needs for 3 months. We evaluated nutritional status, body composition, and biochemical markers of malnutrition.

Results

For 67.9 % of patients, using the equations rather than indirect calorimetry would underestimate energy needs. Individualized HEN resulted in weight loss stops in 46.4 % of patients. The average change in body mass in the study group was positive and was equal to 0.46 ± 6.73 kg. No significant differences were found when comparing the mid-arm circumference (MAC) and triceps skinfold thickness (SFT) before and after inclusion in HEN, although, as in the case of body mass SFT showed an upward trend. Moreover, the percentage of patients with insufficient total protein (TP) and serum albumin concentrations decreased. This difference was statistically significant for albumin. The Nutritional Risk Index (NRI) was also significantly higher. The analysis of body composition also showed a decrease in the percentage of patients with reduced fat-free mass (FFM), body cell mass (BCM), and phase angle (PhA) value.

Conclusions

The results of our research highlight the significance of well-planned nutritional care for cancer patients. Utilizing HEN and individualized approaches can effectively preserve body mass, composition, and nutritional status while minimizing safety risks, ultimately improving quality of life. Indirect calorimetry if available can be helpful to optimize nutrition care for patients with cancer in HEN.