Original article Assessment of energy intake and total energy expenditure in a series of patients who have undergone oesophagectomy following neoadjuvant treatment Jessica Ericson a, b, * , Lars Lundell a, d , Mats Lindblad a, c , Fredrik Klevebro a, c , Magnus Nilsson a, c , Ioannis Rouvelas a, c a Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden b Medical Unit Clinical Nutrition, Stockholm, Sweden c Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden d Department of Surgery, Odense University Hospital, Odense, Denmark article info Article history: Received 22 August 2019 Accepted 9 March 2020 Keywords: Neoadjuvant treatment Oesophagectomy Energy intake Physical activity level Total energy expenditure Sense wear armband summary Background: Assessment of malnutrition and its consequences are important aspects of curative man- agement of patients with oesophageal cancer. The objective of the present study was to assess total energy expenditure using SenseWear Armband Mini® (SWA) as well as energy and protein intake in oesophageal cancer patients submitted to modern multimodality therapy. Material and methods: Twenty patients were recruited at the time of diagnosis of oesophageal cancer. All patients were amenable for curative intended treatment. Baseline measurement was conducted before start of neoadjuvant treatment and three additional measurements were performed: after the comple- tion of neoadjuvant treatment, at three, and six months postoperatively. The patients carried the SWA for three consecutive days at each measurement period, allowing the measurement of the free-living total energy expenditure and physical activity level. Alongside, a three-day complete food diary was recorded for calculation of energy and protein intake. Body weight was measured at all four occasions and weight six months prior to baseline was reported by the patients. Results: Body weight steadily and significantly decreased during the preoperative phase (p ¼ 0.005 and p ¼ 0.007 at 6 months before baseline and after neoadjuvant treatment, respectively). However, the greatest weight loss was observed at 3 months after surgery (mean ¼ 5.6 kg, p  0.001), where after it stabilised. Mean energy intake per day was 2033 (1730e2336) kcal at baseline, and increased to 2236 (2012e2461) kcal (p ¼ 0.012) after completion of neoadjuvant treatment. At 3 months after oesopha- gectomy the daily energy intake decreased to 1759 (1459e2059) kcal (p ¼ 0.155) compared to baseline and regained baseline levels first at 6 months postoperatively. The same trend was observed regarding protein intake. The mean total daily energy expenditure was 2259 (2077e2440) kcal at baseline with no change after the neoadjuvant oncological treatment. A significant reduction in energy expenditure to 1929 (1754e2105) kcal (p ¼ 0.004) compared to baseline was recorded at 3 months post oesophagec- tomy, which remained unchanged at six months after surgery. Conclusion: With the objective to achieve and maintain energy balance, focus must be on the patients' energy intake already at the time of diagnosis, with regular follow up throughout the neoadjuvant therapy phase and during the first 3 postoperative months. © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Neoadjuvant chemoradiotherapy (nCRT) or perioperative chemotherapy (pCT) together with oesophagectomy has become the standard practice in curative intended treatment of * Corresponding author. Medical Unit Clinical Nutrition M 98, Karolinska Uni- versity Hospital, 141 86 Stockholm, Sweden. E-mail address: jessica.ericson@ki.se (J. Ericson). Contents lists available at ScienceDirect Clinical Nutrition ESPEN journal homepage: http://www.clinicalnutritionespen.com https://doi.org/10.1016/j.clnesp.2020.03.007 2405-4577/© 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Clinical Nutrition ESPEN 37 (2020) 121e128