Original article Resting energy expenditure in head and neck cancer patients before and during radiotherapy q Jacqueline A.E. Langius a, * , Hinke M. Kruizenga a , Bernard M.J. Uitdehaag b , Johannes A. Langendijk c , Patricia Doornaert d , C. René Leemans e , Peter J.M. Weijs a a Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands b Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, The Netherlands c Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands d Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands e Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center Amsterdam, The Netherlands article info Article history: Received 3 May 2011 Accepted 15 December 2011 Keywords: Resting energy expenditure Basal metabolism Cachexia Weight loss Head and neck cancer Radiotherapy summary Background & aims: Weight loss is a frequently observed problem in patients with head and neck cancer (HNC) during radiotherapy. It is still to be assessed whether hypermetabolism is contributing to this problem. The aim of this study was to investigate hypermetabolism before radiotherapy, and changes in resting energy expenditure (REE) in HNC patients during radiotherapy. Methods: REE was measured by indirect calorimetry in 71 patients with HNC before radiotherapy, after 3 and 6 weeks of radiotherapy, and 3 months after radiotherapy. The association between REE and tumour stage, CRP, and prior tumour surgery was analyzed by linear regression analyses. Forty healthy control subjects were one-to-one matched to 40 patients by gender, age and fat free mass (FFM) index to compare REE. Results: Before radiotherapy, REE was not significantly different between patients and controls, neither in absolute values (1568  247 vs. 1619  244 kcal/d; p ¼ 0.29), nor after weight-adjustment (22.1  3.5 vs. 21.5  3.3 kcal/kg, p ¼ 0.42) or FFM-adjustment (31.5  4.9 vs. 30.7  4.5 kcal/kg, p ¼ 0.38). REE was independent of tumour stage, CRP, and prior tumour surgery. REE (kcal/d) decreased during radio- therapy and thereafter by 9% from pre-radiotherapy (p < 0.01). Weight and FFM also decreased significantly over time (p < 0.001). REE adjusted for FFM decreased in the first 3 weeks of radiotherapy with 4% (B ¼1.39 kcal/kg FFM, p < 0.01), increased at the end of radiotherapy and decreased again 3 months after radiotherapy (B ¼1.31 kcal/kg FFM, p ¼ 0.04). Conclusions: Head and neck cancer patients had normal REE before radiotherapy. During radiotherapy, REE decreased continuously with ongoing weight loss. However, weight loss is not the only explaining factor, since REE expressed per kg FFM showed a much more divergent course which is currently unexplained. Ó 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction Weight loss is a frequently observed problem in patients with head and neck cancer during radiotherapy, 1e3 mainly resulting from acute radiation-induced side-effects. The daily radiation to the head and neck has a number of side effects, including salivary dysfunction and mucositis with subsequent xerostomia and dysphagia. 4 As a consequence, eating will become difficult and painful, resulting in lower dietary intake 5 and weight loss. 2,6,7 Weight loss may be due to diminished energy intake. However, weight loss may also be due to increased resting energy expendi- ture (REE). Elevated REE has been reported in several groups of cancer patients, like those with lung cancer 8e10 and pancreatic cancer. 10,11 Hypermetabolism in cancer patients is attributed to the cancer cachexia syndrome. Cancer cachexia is a multifactorial syndrome characterized by severe body weight, fat and muscle loss and increased protein catabolism due to underlying disease. 12 Abbreviations: HNC, head and neck cancer; REE, resting energy expenditure; FFM, fat free mass; RT, radiotherapy. q This study was presented in part at the 2nd International Conference on Cancer Nutrition Therapy 2011, Edinburgh, Scotland, and awarded with the biochemical society award. This study was also presented in part at the NVO meeting, March 15 2011, Utrecht, The Netherlands, and awarded with the NVO-ESPEN travel grant. * Corresponding author. Tel.: þ31 204443410; fax: þ31 204444143. E-mail address: j.langius@vumc.nl (J.A.E. Langius). Contents lists available at SciVerse ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu 0261-5614/$ e see front matter Ó 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2011.12.009 Clinical Nutrition xxx (2012) 1e6 Please cite this article in press as: Langius JAE, et al., Resting energy expenditure in head and neck cancer patients before and during radio- therapy, Clinical Nutrition (2012), doi:10.1016/j.clnu.2011.12.009