初诊食管癌患者能量代谢的影响因素和营养风险筛查

目的 研究影响初诊食管癌患者能量代谢的相关因素。方法对2008年11月至2009年6月新华医院40例初诊食管癌患者,采用营养风险筛查2002（NRS2002）进行营养风险筛查,分别应用间接测热法和生物电阻抗法测定其静息能量消耗（REE）和人体组成成分。结果67．5％的初诊食管癌患者存在营养风险,且营养风险评分与其前白蛋白及白蛋白水平分别呈负相关关系（r=-0．444,P=0．004;r=-0．386,P=0．014）。REE实测值和Harris-Benedict公式REE预测值分别为（6770±1360）和（6021±841）kJ／d,两者具有相关性（r=0．503,P=0．001）,且前者显著高于后者（P〈0．001）。40例患者中,57．5％处于高代谢状态,30．0％处于正常代谢状态,12．5％处于低代谢状态。多元线性逐步回归分析显示,在众多营养指标中仅去脂组织对REE值的影响具有统计学意义（P〈0．001）。结论去脂组织是初诊食管癌患者能量代谢的影响因素之一。     

胰腺癌病人静息能量消耗与营养状态关系的研究

目的:通过检测胰腺癌病人的静息能量消耗(REE),评估病人代谢变化的情况,探讨其与营养状态的关系。方法:用间接能量测定法检测34例诊断为胰腺癌的病人(试验组)和同期30例腹股沟疝病人(对照组)的REE。通过人体成分分析仪检测机体组成[体质指数(BMI)、肌肉重、去脂体重、脂肪重、细胞内液量(ICF)、细胞外液量(ECF)等],将REE与营养指标作相关性分析。结果:试验组病人的REE非常显著高于地对照组(P<0.01)。呼吸商(RQ)较对照组明显降低(P<0.01)。试验组病人的BMI、体重、肌肉群、去脂体重、脂肪、细胞内液量等与对照组比显著减少(P<0.05);细胞外液量较对照组显著增加(P<0.05)。胰腺癌病人的REE与肌肉重、去脂体重、细胞内液均有显著负相关性(P<0.05),与脂肪重无显著相关性(P>0.05)。胰腺癌各病人REE的变化并不相同,其中REE升高者为55.88%,REE正常者为29.41%,REE降低者为14.71%。结论:胰腺癌病人REE显著增加,营养状况显著低下。REE的升高与营养不良相关性。     

结肠癌病人化疗前后的能量代谢测定及人体成分分析

目的:测量结肠癌病人化疗前后能量代谢和人体成分,以评估其化疗前后的营养状况。方法:选择结肠癌病人51例,采用自身对照研究方法,于化疗前2 d和化疗后第2天,采用床旁代谢仪测量静息能量代谢(REE),并采用人体成分分析仪对病人进行人体成分分析。结果:所有结肠癌病人化疗后第2天的REE与化疗前2 d比较均显著降低,且差异有显著性统计学意义(P0.05)。化疗后体脂百分数增加,瘦体质量百分数降低,身体水分百分数增加。体脂百分数、瘦体质量百分数与身体水分百分数均值差异均有统计学意义(P0.05)。结论:结肠癌病人化疗后静息能量消耗与化疗前比呈下降趋势,体脂百分数增加,瘦体质量百分数降低,身体水分百分数增加。     

Prospective study of resting energy expenditure changes in head and neck cancer patients treated with chemoradiotherapy measured by indirect calorimetry

OBJECTIVE: The prevalence of malnutrition is high in patients with head and neck cancer due to tumor location and coadjuvant treatment. We studied changes in resting energy expenditure (REE) during treatment with chemoradiotherapy and compared the measured REE by indirect calorimetry (IC) with the value estimated by the Harris-Benedict (HB) formula. METHODS: Eighteen patients with head and neck cancer (15 men and 3 women, mean age 57 +/- 10.7 y, age range 30-71 y) entered the study. All patients were treated with radiotherapy (70.8 +/- 1 Gy, range 70-72) and received 37.4 +/- 3.5 fractions (range 32-42) and concurrent chemotherapy with cisplatinum (absolute doses of 400 to 1000 mg). Nutrition assessment included anthropometry (body mass index, triceps skinfold thickness, subscapular skinfold thickness, midarm circumference, and midarm muscle circumference) and tetrapolar bioimpedance (Holtain BC). The IC (kcal/24 h; Deltatrac II MBM-200) was performed after an overnight fast. Measurements were done before treatment, at weeks 2, 4, and 6 of treatment, at the end of treatment, and 2 wk after treatment. RESULTS: Body mass index decreased during treatment from 24.7 +/- 4.4 kg/m(2) (range 16.9-31.4) to 22.3 +/- 4.2 kg/m(2) (range 15.1-29.6). REE (kcal/24 h) changed significantly during treatment (IC P < 0.05, HB formula P < 0.001). REE measured by IC appeared as a U-shaped curve, but REE estimated by the HB formula decreased during treatment. The HB underestimated REE measurements compared with IC. These differences were statistically significant before treatment, at the end of treatment, and 2 wk after treatment (P < 0.05) and showed a limited clinical agreement with the Bland-Altman method. CONCLUSIONS: REE measured by IC significantly changed during chemoradiotherapy. It was higher before treatment, at the end of treatment, and 2 wk after treatment. The HB formula underestimated REE in these patients. IC is a suitable method for measuring REE in this cohort of patients.     

Influence of resting energy expenditure on weight gain in adolescents taking second-generation antipsychotics

Background & aims

: Weight gain is an undesirable side effect of second-generation antipsychotics (SGAs). We performed this study to examine the influence of SGAs on resting energy expenditure (REE) and the relationship of REE to weight gain in adolescent patients.

Methods

Antipsychotic-naïve or quasi-naïve (<72 h of exposure to antipsychotics) adolescent patients taking olanzapine, quetiapine, or risperidone in monotherapy were followed up for one year. We performed a prospective study (baseline, 1, 3, 6, and 12 months after treatment) based on anthropometric measurements, bioelectrical impedance analysis, and indirect calorimetry (Deltatrac™ II MBM-200) to measure REE. We also analyzed metabolic and hormonal data and adiponectin concentrations.

Results

Forty-six out of the 54 patients that started treatment attended at least 2 visits, and 16 completed 1 year of follow-up. Patients gained 10.8 ± 6.2 kg (60% in the form of fat mass) and increased their waist circumference by 11.1 ± 5.0 cm after 1 year of treatment. The REE/kg body mass ratio decreased (p = 0.027), and the REE/percentage fat-free mass (FFM) ratio increased (p = 0.007) following the fall in the percentage of FFM during treatment. Weight increase was significantly correlated with the REE/percentage FFM ratio at all the visits (1–3–6–12 months) (r = 0.69, p = 0.004 at 12 months).

Conclusions

SGAs seem to induce a hypometabolic state (reflected as decreased REE/kg body mass and increased REE/percentage FFM). This could explain, at least in part, the changes in weight and body composition observed in these patients.     

Anthropometric measured fat-free mass as essential determinant of resting energy expenditure for pregnant and non-pregnant women

Objective

There is conflicting evidence as to whether anthropometric parameters are related to resting energy expenditure (REE) during pregnancy. The aim of this prospective longitudinal study was to precisely assess a major anthropometric determinant of REE for pregnant and non-pregnant women with verification of its use as a possible predictor.

Methods

One hundred fifty-two randomly recruited, healthy, pregnant Czech women were divided into groups G1 and G2. G1 (n = 31) was used for determination of the association between anthropometric parameters and REE. G2 (n = 121) and a group of non-pregnant women (G0; n = 24) were used for verification that observed relations were suitable for the prediction of REE during pregnancy. The women in the study groups were measured during four periods of pregnancy for REE by indirect calorimetry and anthropometric parameters after 12 h of fasting.

Results

Associations were found in all groups between measured REE by indirect calorimetry and anthropometric parameters such as weight, fat mass, fat-free mass (FFM), body surface area, and body mass index (P < 0.0001). The best derived predictor, REE/FFM (29.5 kcal/kg, r = 0.70, P < 0.0001), in group G1 was statistically verified in group G2 and compared with G0.

Conclusion

Anthropometrically measured FFM with its metabolically active components is an essential determinant of REE in pregnancy. REE/FFM can be used for the prediction of REE in pregnant and non-pregnant woman.     

恶性肿瘤患者静息能量代谢研究现状

能量代谢可以反映人体代谢基本情况,不同生理或病理时期机体代谢特征不同.恶性肿瘤负荷状态下,多数患者处于高能耗状态,但也有部分患者静息能量代谢无明显变化,这种改变可能与肿瘤的类型、病理分期、治疗手段及实验方法等因素密切相关.治疗效果对肿瘤患者静息能量消耗可产生不同影响:治疗有效时,患者静息能量消耗可恢复至正常;治疗无效时,患者静息能量代谢无改善甚至能耗量增加.恶性肿瘤患者能量代谢异常的机制可能与机体营养物质代谢异常及相关细胞因子调控有关.

Abstract：

Energy metabolism varies in different periods during the lifetime or in different pathological states. Resting energy expenditure (REE) may increase in some patients with malignant tumors, but may also show no significant difference when compared with healthy people or patients with benign tumors. The alteration of REE may be related to tumor site, pathologic stage, methods of treatment, and/or laboratory tests. The efficacy of a certain therapy may also affect REE in patients with malignant tumors: when a therapy is effective, the value of REE can return normal; however, when the treatment fails, REE will not be improved or become even higher.Mechanism governing the abnormalities of REE in patients with malignant tumors may be associated with the abnormal nutrition metabolism and the regulations of relevant cytokines.     

恶性肿瘤病人静息能量消耗研究的进展

处于不同生理或病理状态的机体 ,能量代谢特征不尽相同。在癌症病人中 ,由于肿瘤生长以及由此产生的机体代谢变化 ,使得肿瘤病人的能量代谢有其特殊性。本文对肿瘤病人的静息能量消耗研究进展进行了综述。一般认为 ,恶性肿瘤病人术前静息能量代谢较正常人有所升高 ,但有资料显示某些恶性肿瘤病人术前能量代谢并无变化。肿瘤部位、大小、分期、分型、治疗措施等的不同 ,对人体代谢有不同影响 ,且不同资料之间还存在着彼此矛盾之处     

血糖稳定的2型糖尿病患者的静息能量消耗

目的观察血糖控制良好的2型糖尿病患者静息能量消耗（REE）的特点。方法采用代谢车测量45例血糖稳定的2型糖尿病患者的REE,记录其一般情况、生化指标、Harris-Benedict和Owen公式计算基础能量消耗预测值,并进行比较分析。结果血糖稳定的2型糖尿病患者的静息能量消耗实测值与Harris-Benedict及Owen公式预测值比较差异无统计学意义（P〉0．05）,相关分析显示REE与性别、年龄、体重、身高、体表面积、去脂组织显著相关（P〈0．05）,与体重指数、脂肪组织、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、三酰甘油、总蛋白、白蛋白、血红蛋白无相关性（P〉0．05）,多元逐步回归分析显示去脂组织和年龄与REE关系最密切。结论血糖良好的2型糖尿病患者的REE并不增高,决定其REE的因素与健康个体相似,测定REE能更好地指导糖尿病的医学营养治疗。     

Regional lean body mass and resting energy expenditure in non-obese adults

Summary Objective To study the effect of regional lean body mass (LBM) on resting energy expenditure (REE). Design Cross-sectional study in a homogenous group of 26 young healthy non-obese subjects. Methods Regional body composition was assessed by dual-energy X-ray absorptiometry (DEXA). REE was measured by indirect calorimetry. Results REE showed positive relationships with whole body LBM (LBM_b; r=0.89) as well as with regional LBM (LBM_trunk = LBM_t, r = 0.88, and LBM_arms+legs = LBM_e for LBM_extremities, r = 0.89) with non-zero intercepts (between 1.86 and 2.83 MJ/d). REE per kg LBM_b falls as LBM_b increases (r = 0.77). By contrast, REE adjusted for regional distribution of LBM (i. e. the ratio of LBM_t to LBM_e) increases as LBM_b increases (r = 0.91) showing a near-zero intercept (i. e. 0.048 MJ/d). Adjusting REE for LBM_b as well as for the ratio of LBM_t to LBM_e can be used for comparison between subjects. Conclusions Our data suggest that regional distribution of LBM is a determinant of REE. Assessment of LBM_t and LBM_e by DEXA provides a possibility to adjust for the non-linearity of REE on LBM_b. Received: 11 April 2001, Accepted: 12 June 2001     

Ideal weight better predicts resting energy expenditure than does actual weight in patients with short bowel syndrome

OBJECTIVE: The objective of the present study was to compare measured energy expenditure with predicted energy expenditure in patients with short bowel syndrome. METHODS: Thirteen patients with short bowel syndrome underwent anthropometric measurements and indirect calorimetry for the determination of resting energy expenditure. Energy expenditure was also estimated by use of the Harris-Benedict equation with current weight and ideal weights. RESULTS: The difference between measured energy expenditure and energy expenditure estimated by use of current weight was statistically significant, whereas the difference between measured energy expenditure and energy expenditure estimated by use of ideal weight was not significant. CONCLUSION: The energy expenditure of patients with short bowel syndrome can be estimated by use of the Harris-Benedict equation and patients' ideal weight.