Energy intake, particularly energy density (ED), is positively associated with energy balance in patients with advanced cancer, report Swedish researchers.
However, the association loses significance when systemic inflammation is taken into account, writes the team in Clinical Nutrition, indicating that ingestive behavior and choice of food change in the presence of inflammation.
"Our results thus highlight the importance of targeting systemic inflammation in the prevention and treatment of cancer cachexia with nutrition support," say Ola Wallengren (Sahlgrenska University Hospital, Gothenburg) and co-workers.
"Exchanging several foods and beverages for corresponding energy-dense options could increase diet ED substantially," they suggest, explaining that weight loss reflects a negative energy balance and has an adverse effect on patient outcomes.
The team used dual-energy X-ray scans to calculate the change in body energy content in 107 patients (61 men) with advanced cancer over a 16-month period. Study participants submitted a 4-day food and drink record to indicate approximate energy intake.
Patients had an average energy intake of just 28 kcal/kg/day at their first visit and 63% of patients had systemic inflammation, defined as an erythrocyte sedimentation rate value of greater than 20. ED was a significant 9% lower among patients with systemic inflammation than among those without.
The ED of solid food was a positive predictor for energy balance. Data showed that one standard deviation increase in ED and energy intake increased energy balance by 38 and 41 kcal/day, respectively.
However, after adjusting for survival duration and inflammatory status, neither ED nor ED of solid food were predictive of energy balance.
Median survival among patients with systemic inflammation was a nonsignificant 3.1 months shorter than among those without inflammation, and those with inflammation had a lower overall energy intake relative to their bodyweight.
Indeed, ED and ED of solid food were a significant 9% and 8% lower, respectively, among participants with systemic inflammation than among those without.
The researchers conclude that "targeting systemic inflammation may be highly important in nutritional interventions in this patient group."
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