Assessing Energy Expenditure in Cancer Patients: A Pilot Validation of a New Wearable Device

Abstract

Background: Nutrition problems are common in cancer patients and are frequently due to metabolic derangements. Thus, accurately assessing energy expenditure (EE) is important in planning adequate nutrition support. Indirect calorimetry (IC) represents the gold standard method but is not always available or applicable to all settings. The purpose of this study was to preliminary compare a new wearable device, the SenseWear armband (SWA), to IC in cancer patients. Methods: Ten (6 M, 4 F) subjects (mean± SD: 56.6 ± 13.3 years) affected by newly diagnosed acute myelogenous leukemia, undergoing induction chemotherapy, were prospectively enrolled. Resting EE (REE) was measured simultaneously by SWA and IC on admission (day 0) and at discharge (end). Total daily EE (TDEE) was determined by SWA 4 times during the stay (days 0, 7, 14, and end) and predicted values were calculated according to IC REE estimates (TDEE = IC × correction factor 1.2). Results: Mean length of stay was 27.1 ± 6.2 days. Bland-Altman plots revealed no significant differences between overall REE estimates (day 0 + end) performed by IC and SWA (mean ± SD; 1645± 282 vs 1705 ± 278 kcal/d) and the correlation was high (r = 0.84; p < .0001). SWA TDEE showed a progressive reduction during the stay. No bias was detected between overall SWA TDEE (1799± 153 kcal/d) and IC predicted TDEE (1974 ± 176 kcal/d), but there was a wide 95% confidence interval (–672; +321 kcal/d). Moreover, the correlation between these values was significant (r = 0.68; p = .001). Conclusions: SWA seems to provide accurate and reliable estimation of REE and useful information on TDEE also in cancer patients. Its use appears promising. Validation studies on larger samples and different cancer types should be considered.

SenseWear Armband is a new wearable device for measuring energy expenditures. Although it was previously validated only on healthy subjects, its use preliminarily appears promising also for the cancer patient, providing there is accurate estimation of resting energy expenditures and useful information about total daily energy expenditures.

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References

Barrera R. Nutritional support in cancer patients. JPEN J Parenter Enteral Nutr. 2002 ;26(5 Suppl):S63– S71.

Inui A. Cancer anorexia-cachexia syndrome: current issues in research and management. CA Cancer J Clin. 2002 ;52:72– 91.

Chute CG, Greenberg ER, Baron J, Korson R, Baker J, Yates J. Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont. Cancer. 1985 ;56:2107– 2111.

Eriksson KM, Cederholm T, Palmblad JE. Nutrition and acute leukemia in adults: relation between nutritional status and infectious complications during remission induction. Cancer. 1998 ;82:1071– 1077.

Garcia-Peris P, Lozano MA, Velasco C, et al. Prospective study of resting energy expenditure changes in head and neck cancer patients treated with chemoradiotherapy measured by indirect calorimetry.Nutrition. 2005;21:1107– 1112.

Lerebours E, Tilly H, Rimbert A, Delarue J, Piguet H, Colin R. Change in energy and protein status during chemotherapy in patients with acute leukemia. Cancer. 1988;61:2412– 2417.

Muscaritoli M, Grieco G, Capria S, Iori AP, Rossi Fanelli F. Nutritional and metabolic support in patients undergoing bone marrow transplantation. Am J Clin Nutr. 2002 ;75:183– 190.

Arends J, Bodoky G, Bozzetti F, et al. ESPEN Guidelines on enteral nutrition: non-surgical oncology. Clin Nutr. 2006 ;25:245– 259.

Barak N, Wall-Alonso E, Sitrin MD. Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. JPEN J Parenter Enteral Nutr. 2002 ;26:231– 238.

10.

Delarue J, Lerebours E, Tilly H, et al. Effect of chemotherapy on resting energy expenditure in patients with non-Hodgkin's lymphoma: results of a sequential study. Cancer. 1990 ;65:2455– 2459.

11.

Reeves MM, Battistutta D, Capra S, Bauer J, Davies PS. Resting energy expenditure in patients with solid tumors undergoing anticancer therapy. Nutrition. 2006 ;22:609– 615.

12.

Jakicic JM, Marcus M, Gallagher KI, et al. Evaluation of the SenseWear Pro armband to assess energy expenditure during exercise. Med Sci Sports Exerc. 2004;36:897– 904.

13.

Fruin ML, Rankin JW. Validity of a multi-sensor armband in estimating rest and exercise energy expenditure. Med Sci Sports Exerc. 2004;36:1063– 1069.

14.

Malavolti M, Pietrobelli A, Dugoni M, et al. A new device for measuring resting energy expenditure (REE) in healthy subjects. Nutr Metab Cardiovasc Dis. 2007;17:338– 343.

15.

St-Onge M, Mignault D, Allison DB, Rabasa-Lhoret R. Evaluation of a portable device to measure daily energy expenditure in free-living adults.Am J Clin Nutr. 2007;85:742– 749.

16.

Frankenfield DC, Muth ER, Rowe WA. The Harris-Benedict studies of human basal metabolism: history and limitation. JAm Diet Assoc. 1998 ;98:439– 445.

17.

Mignault D, St-Onge M, Karelis AD, Allison DB, Rabasa-Lhoret R. Evaluation of the portable HealthWear armband: a device to measure total daily energy expenditure in free-living type 2 diabetic individuals. Diabetes Care. 2005;28:225– 227.

18.

Cole PJ, LeMura LM, Klinger TA, Strohecker K, McConnell TR. Measuring energy expenditure in cardiac patients using the Body Media armband versus indirect calorimetry: a validation study. J Sports Med Phys Fitness. 2004;44:262– 271.

19.

Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J. 2006 ;27:1040– 1055.

20.

Stewart CL, Goody CM, Branson R. Comparison of two systems of measuring energy expenditure. JPEN J Parenter Enteral Nutr. 2005 ;29:212– 217.

21.

Fouladiun M, Korner U, Bosaeus I, Daneryd P, Hyltander A, Lundholm KG. Body composition and time course changes in regional distribution of fat and lean tissue in unselected cancer patients on palliative care: correlations with food intake, metabolism, exercise capacity, and hormones.Cancer. 2005;103:2189– 2198.