Comment on Accuracy of Resting Energy Expenditure Predictive Equations in Patients With Cancer

Souza, Micheline Tereza Pires de; Singer, Pierre; Ozorio, Gislaine Aparecida; Alves-Almeida, Maria Manuela Ferreira; Waitzberg, Dan Linetzky

doi:10.1002/ncp.10429

Nut in Clin Prac

2019

DOI: 10.1002/ncp.10429

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Comment on Accuracy of Resting Energy Expenditure Predictive Equations in Patients With Cancer

Micheline Tereza Pires de Souza

Pierre Singer

Gislaine Aparecida Ozorio

et al.

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Cited by 2 publications

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“…We would like to thank Souza et al for their interest in our work and commending our efforts in the area of oncology energy metabolism in their recent letter . On a similar note, this research group's investigations have been equally beneficial in contributing to improving current understanding of nutrition oncology.…”

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Response to Comment on Accuracy of Resting Energy Expenditure Predictive Equations in Patients With Cancer

Purcell

Prado

2019

Nut in Clin Prac

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We would like to thank Souza et al for their interest in our work 1 and commending our efforts in the area of oncology energy metabolism in their recent letter. 2 On a similar note, this research group's investigations have been equally beneficial in contributing to improving current understanding of nutrition oncology. The authors made several excellent points in the letter we would like to expand upon.As originally stated in our discussion and corroborated by the letter from Souza et al, error from the Souza-Singer equation 3 may be partially due to the differences in study populations. Although some previous research has indeed reported differences in resting energy expenditure (REE) among cancer types, 4 we found that this did not translate to differences in "equation accuracy" among tumor types and stages in our study. REE alterations in response to cancer may therefore be negligible compared with error in predictive equations, at least among certain tumor groups (ie, colon, rectal, or lung cancer, as we investigated).Another potential source of error arises from the differences in body composition techniques. The Souza-Singer equation was developed using bioelectrical impedance analysis (BIA). Using this particular tool has better clinical applicability since more accurate methods such as dual xray absorptiometry (DXA) are rarely routinely conducted in practice. However, compared with DXA, BIA may underestimate fat mass and overestimate fat-free mass (resulting in high individual-level error), 5 and body composition equations using BIA-derived data should be population specific. 6 Despite potential discrepancies between BIA and DXA, we chose to include the Souza-Singer equation in our publication because of its novelty and specificity to cancer (albeit among patients with head and neck cancer). Future research should build upon the estimation of energy requirements with various anthropometric and body composition techniques while also considering differences in results among manufacturers and versions of devices.As noted by Souza et al and others, tumor location and stage may impact REE. 4,7,8 This raises several questions for nutrition practice. Should cancer location/stage be considered in total energy expenditure (and therefore energy re-quirement) estimations? Can we assume energy metabolism is similar across certain tumor groups but not others? How much additional accuracy is gained when other factors (ie, cancer stage, systemic inflammation, body composition) are included in predictive equations, and should these be considered in future energy needs calculations?We believe the original publication by Souza et al and our findings on equation accuracy also reinforce the need for external validation of novel techniques or equations. Internal and external validations have been proposed as part of a 7-step guideline for validation of clinical prediction models. 9 Research collaboration using similar databases (ie, body composition and REE measured with comparable techniques) would help facilitate optimal e...

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Response to Comment on Accuracy of Resting Energy Expenditure Predictive Equations in Patients With Cancer

Purcell

Prado

2019

Nut in Clin Prac

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Effect of age on resting energy expenditure in patients with cancer

et al. 2022

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Comment on Accuracy of Resting Energy Expenditure Predictive Equations in Patients With Cancer

Cited by 2 publications

References 7 publications

Response to Comment on Accuracy of Resting Energy Expenditure Predictive Equations in Patients With Cancer

Response to Comment on Accuracy of Resting Energy Expenditure Predictive Equations in Patients With Cancer

Effect of age on resting energy expenditure in patients with cancer

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